MOU - 25-30 SWFAC MOU WITH PHOENIX CHILDRENS AND HONOR HEALTH DOC 30827 ADD SIGN.PDF
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MOU
SOUTHWEST FAMILY ADVOCACY CENTER
MEMORANDUM OF UNDERSTANDING
BETWEEN
THE FOLLOWING PARTICIPATING
AGENCIES:
CITY OF AVONDALE,
CITY OF GOODYEAR,
CITY OF BUCKEYE,
STATE OF ARIZONA - DEPARTMENT OF
CHILD SAFETY
MARICOPA COUNTY – COUNTY
ATTORNEY’S OFFICE,
MARICOPA COUNTY – COUNTY SHERIFF’S
OFFICE,
HONORHEALTH,
AND
PHOENIX CHILDREN’S HOSPITAL, INC.
The City of Avondale Southwest Family Advocacy Center (“Center”), pursuant to various
Intergovernmental Agreements, was created to provide integrated services for victims of abuse
through the collaboration of the City of Avondale (“Avondale”), City of Buckeye (“Buckeye”),
City of Goodyear (“Goodyear”), Maricopa County (“Maricopa”), and the State of Arizona
Department of Child Safety (collectively referred to as “Governmental Agencies” for the purposes
of the Memorandum of Understanding). See Attachments 1 and 2.
One of the core missions of the Center is to provide on-site collaboration and the use of multi-
disciplinary team approach for children who are victims of abuse. This multidisciplinary team
approach is used for prevention, investigation, protection, medical assessment, and referral
for prosecution and treatment of children who are victims of abuse.
Honor Health and Phoenix Children Hospital (collectively referred to as “Nonprofit
Organizations”) employ forensic teams who conduct forensic medical examinations of children
who are victims of abuse.
We, the undersigned Nonprofit Organizations and Governmental Agencies, agree to this
Memorandum of Understanding (“MOU”) which memorializes our support of policies, services
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SOUTHWEST FAMILY ADVOCACY CENTER
and programs provided by Center to assist children who are victims of abuse.
We recognize that children who have been abused have specific needs and may be in a fragile
state through no fault of their own. Our current systematic response to the needs of abused
children in Maricopa County includes a wide array of professional services from both public and
private sectors.
We recognize that a coordinated, collaborative and systematic response enhances the investigative
process and provides for the immediate medical and therapeutic treatment therefore improving
the welfare of children. Having recognized these things, the undersigned support
coordination between the Governmental Agencies and the Nonprofit Organizations.
Each of the undersigned agrees to support the provisions outlined in the MOU and the provisions
and policies set forth in the Center’s Operation Manual in an effort to implement the
multidisciplinary coordination efforts, including multidisciplinary investigations.
We acknowledge that the multidisciplinary team approach through the Center will serve to
enhance the individual efforts of each of the undersigned entities.
We acknowledge that through the coordination of the Governmental Agencies and Nonprofit
Organizations, and through community support and awareness, the Center will assist in
coordinating efforts to ensure the protection and preservation of the children of Arizona.
GENERAL PROVISIONS
1.
Each Governmental Agency and Nonprofit Organization will work with and
assist Center to ensure that the best interests and protection of children will be served.
2.
Each Governmental Agency and Nonprofit Organization shall participate at
the Center as resources allow.
3.
All reasonable efforts will be made by each Governmental Agency and Nonprofit
Organization to coordinate each step of the investigative process in order to minimize the number
of interviews and medical exams to which a child is subjected to at the Center.
4.
Each Governmental Agency and Nonprofit Organization, through its duly
authorized representative(s) will participate in regularly established multi-agency case reviews.
5.
Each Governmental Agency and Nonprofit Organization will agree to assist,
to a reasonable level and as resources allow the Center with the collection of information for
case tracking purposes.
6.
Each Governmental Agency and Nonprofit Organization will be invited and
encouraged to attend training sponsored by the Center. The Center may, but is not obligated
to, provide financial support for professionals and volunteers to attend specialized training in
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Center’s sole discretion.
7.
All Center volunteers must meet the criteria set forth by the Center in order to
qualify as volunteers.
8.
It is expressly understood that each Governmental Agency and Nonprofit
Organization will work within its departmental mandates and policies. Nothing contained herein
supersedes the statutes, rules and regulations governing each Governmental Agency and
Nonprofit Organization.
9.
Each Governmental Agency and Nonprofit Organization participating at the
Center agrees, as resources allow, to provide specially trained professionals with skills in
interviewing, assessment, and investigation to handle appropriate cases of child sexual and
physical abuse.
10.
Any conflicts or divergence from protocols and procedures that occur regarding
cases being addressed by the Center shall be discussed and evaluated at the disciplinary team
meeting to define a solution acceptable to all parties.
11.
Each Governmental Agency and Nonprofit Organization wishes to protect the
confidentiality of certain confidential information disclosed solely for use as part of the
multidisciplinary team under this MOU (the “Permitted Use”).
12.
Any Governmental Agency or Nonprofit Organization (the “Disclosing Party”)
may disclose or make available to another MOU participant (the “Receiving Party”), whether
orally or in physical or electronic form, confidential or proprietary information concerning the
Disclosing Party and/or its activities, cases, business, products, services, marketing, or
promotional or technical information in connection with this MOU, which shall include the
terms and conditions of this MOU (collectively, the “Confidential Information”). For purposes
hereof Confidential Information will not include information (i) that was previously known to
the Receiving Party without an obligation of confidentiality; (ii) that was acquired by the
Receiving Party from a third party that was not, to the Receiving Party’s knowledge, under an
obligation to not disclose such information; (iii) that is or becomes publicly available through
no fault of Receiving Party; or (iv) that the Disclosing Party gave written permission to the
Receiving Party to disclose. If applicable, all parties to this MOU will comply with A.R.S. §
8-807.
13.
Except as otherwise required by applicable law, each Receiving Party agrees that
(i) it will use the Confidential Information of the Disclosing Party solely for the Permitted Use
and (ii) it will not disclose the Confidential Information of the Disclosing Party to any third party
other than the Receiving Party’s employees or agents, on a need-to-know basis, who are bound
by obligations of nondisclosure and limited use at least as strict as those contained herein. The
Receiving Party will protect the Confidential Information of the Disclosing Party in the same
manner that it protects the confidentiality of its own proprietary and confidential information and
materials of like kind, but in no event less than a reasonable standard of care. The Receiving
Party is responsible for any breach of the confidentiality provisions of this MOU by its
employees or agents. In the event the Receiving Party receives a subpoena or other validly issued
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administrative or judicial process demanding the Confidential Information, the Receiving Party
will give the Disclosing Party prompt written notice of the subpoena or demand so that the
Disclosing Party may assert any defenses to disclosure that may be available. Any such defenses
must be asserted within thirty (30) days of the Disclosing Party’s written notice. Confidential
Information disclosed by the Disclosing Party to the Receiving Party will at all times remain the
exclusive property of the Disclosing Party. The Receiving Party shall not receive any right, title,
or interest in, or any license or right to use, Confidential Information or any intellectual property
rights therein, by implication or otherwise except as explicitly provided herein.
14.
Except as otherwise required by applicable law, the Receiving Party shall, upon
the termination of this MOU or the request of the Disclosing Party, return to the Disclosing Party
all Confidential Information received by the Receiving Party from the Disclosing Party and all
Confidential Information in the Receiving Party’s possession or control (and all copies and
reproductions thereof). Alternatively, at the Receiving Party’s option, the Receiving Party shall
destroy all Confidential Information received by the Receiving Party from the Disclosing Party
(and all copies and reproduction thereof) and any notes, reports, or other documents prepared
by the Receiving Party that contain Confidential Information. Notwithstanding the return or
destruction of the Confidential Information, the Receiving Party will continue to be bound by
the obligations, including confidentiality, hereunder.
15.
All Governmental Agencies and Nonprofit Organizations further agree to comply
with any and all federal and state laws, rules and regulations regarding the confidentiality of
medical information and health care records included in such Confidential Information. To the
extent such requirements apply to this MOU, each entity will comply with its own rules,
regulations and policies required by state and federal law, including without limitation, the Health
Insurance Portability and Accountability Act and its implementing regulations (collectively
"HIPAA") where applicable.
16.
Any public announcement or press release that specifically references the Center
shall be reviewed and approved by the Center prior to the release. The Governmental Agency or
Nonprofit Organization shall provide the public announcement or press release to the Center at
fifteen (15) days prior to release. The use of the Center’s name, logo or intellectual property
require prior written approval. Nothing in this MOU shall be deemed to grant to any Agency any
right related to any of the trademarks, trade name, or good will of the Center.
17.
Subject to the protections provided to Confidential Information in Section 11
above, each Agency participating at the Center will immediately share pertinent case information
as permitted by protocol and all applicable law, including HIPAA.
18.
The Governmental Agencies and Nonprofit Organizations will work to
identify strategies that raise public awareness regarding prevention, identification,
investigation, intervention, and treatment of child abuse.
19.
The Governmental Agencies and Nonprofit Organizations shall support the
Center to meet the Standards of Accreditation set forth by National Children's Alliance. See
Attachment 3.
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20.
The Governmental Agencies and Nonprofit Organizations intend to create a
collaboration and not a partnership. No provision of this MOU shall be construed or deemed to
create any joint venture, joint enterprise, or agency relationship among the undersigned entities,
and no undersigned entity shall have the right to enter into contracts on behalf of, to legally bind,
to incur debt on behalf of, or to otherwise incur any liability or obligation on behalf of the other
undersigned entities hereto, in the absence of a separate writing, executed by an authorized
representatives. Each Governmental Agency and Nonprofit Organization shall be solely
responsible for its representatives, employees, and contractors. All undersigned entities shall not
hold themselves out as employees or agents of each other. No entity shall withhold on behalf of
the employees of another, any sums for income tax, unemployment insurance, social security or
any other withholding or benefit pursuant to any law or requirement of any governmental body.
Nothing in this MOU is intended nor shall be construed to create an employer/employee
relationship, or to allow the undersigned entities to exercise control over one another in the manner
in which their employees or agents perform services which are the subject of this MOU.
21.
Each undersigned entity hereto (the “Indemnifying Party”) agrees to defend,
indemnify, and hold harmless each of the other undersigned entities (each, an “Indemnified
Party”) and their successors, permitted assigns, estates, executors and heirs, to the fullest extent
permitted by applicable Arizona law and federal law against all claims, damages, losses,
liabilities, costs and expenses (collectively “Losses”) incurred by the Indemnified Parties to the
extent that such Losses arise from or are due to (i) the negligence, willful misconduct or fraud of
the Indemnifying Party; and/or (ii) a breach of any of the terms, conditions, representations or
warranties of this MOU.
22.
The Indemnified Parties shall provide prompt notice to the Indemnifying Party of
any potential claim subject to indemnification hereunder; provided, however, that failure to give
such notification shall not affect the indemnification provided under this MOU except to the extent
the Indemnifying Party shall have been materially prejudiced as a result of such failure. The
Indemnifying Party shall assume the defense of the claim through legal counsel designated by it
and reasonably acceptable to the Indemnified Parties, provided that each Indemnified Party may
obtain separate legal counsel at its own expense. The Indemnifying Party shall not settle or
compromise any claim, or consent to the entry of any judgment, without the prior written consent
of the Indemnified Parties, which consent shall not be unreasonably withheld, conditioned or
delayed. The Indemnified Parties shall cooperate with the Indemnifying Party in the defense of a
claim, provided that such cooperation shall be at the Indemnifying Party’s expense and within
reasonable limitations.
23.
No undersigned entity shall be liable to the other for lost profits or business,
indirect, consequential or punitive damages, whether based in contract or tort (including
negligence, strict liability or otherwise), and whether or not advised of the possibility of such
damages.
24.
Each undersigned entity agrees that none of the Center’s directors, officers,
employees, or any of their respective agents shall have any personal obligation hereunder, and that
no undersigned entity shall not seek to assert any claim or enforce any of their rights hereunder
against any of the other undersigned entities. The limitations set forth in this paragraph shall
survive any cancellation, expiration, or termination, for any reason, of this MOU.
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25.
No Governmental Agency or Nonprofit Organization shall be responsible for the
negligence or wrongful acts/omissions of another party, its officers, trustees, directors, or
employees.
26.
This MOU is not intended to and shall not confer upon any other person or business
entity, other than the parties hereto, any rights or remedies with respect to the subject matter of this
MOU.
SPECIAL AGENCY PROVISIONS
1. The City of Avondale, City of Goodyear, City of Buckeye, and Maricopa County (Sheriff’s
Office) shall:
•
Utilize the Center as the primary office for the Lieutenant, Detectives and civilian staff
of the of the Center to assist with child abuse investigations.
•
Exercise final authority regarding all criminal processes involving cases that
originate in the respective entity’s jurisdiction including those conducted jointly
with the Department of Child Safety and/or other entities.
•
Not knowingly or intentionally bring a suspected abuser to the Center.
2. The Department of Child Safety (DCS) shall:
•
For cases assigned to the Office of Child Welfare Investigations (“OCWI”) unit of DCS,
coordinate with signatory entities to protect children who are served by Center to conduct
investigations, assess degree of risk and coordinate services for the children and their
families.
•
Exercise final authority regarding DCS administrative processes including those
conducted jointly with the any of the undersigned entities.
3. The Maricopa County Attorney's Office shall:
•
Be responsible for assessing the legal aspects of the cases subject to this MOU in accordance
with its prosecutorial role.
4. Phoenix Children's Hospital and Honor Health shall:
•
Utilize its respective forensic teams to provide unbiased forensic medical examinations
on children presenting to the Center with allegations of abuse.
•
If applicable, have the sole and exclusive right to charge, bill, collect and retain all
monies received for its professional services provided to patients encountered due to
this MOU.
5. The Center shall:
•
Provide signatory agencies in this MOU with a professional working environment
including administrative and facilities support to ensure child abuse cases are handled
properly.
•
Provide, at a minimum, immediate crisis intervention by specialized therapists to
respond to children and non-offending caregivers during the investigation process at
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the Center.
•
Provide specialized, dedicated staff to conduct forensic interviews of children alleging
abuse.
•
Provide victim advocacy through either dedicated staff and/or involvement from mental
health staff.
•
Facilitate regularly scheduled review of cases presented at the Center. Facilitate regularly
scheduled peer review of forensic interviews.
EFFECTIVE DATE, MODIFICATION, TERMINATION AND ADDITONAL
PROVISIONS
1. This MOU will be effective on November 1, 2025, and will remain in effect for a period of five
years from the date of signature, unless terminated earlier in accordance with termination
requirements outlined in this MOU.
2. This MOU shall only be modified with the consent of all signatory entities.
3. The MOU and guidelines may be terminated by written notice, submitted to all signatories.
Any party may terminate the MOU and Provisions, without or without cause, by providing
thirty (30) days' written notice. Upon termination of this MOU, all rights and obligations of
the Agencies shall cease, except those rights and obligations that have accrued or expressly
survive, or that by their terms are intended to survive, such termination.
4. Parties of this MOU, whether housed at the Center or not, agree to the guidelines and provisions
as outlined in this MOU.
5. ARBITRATION: The parties to this MOU agree to resolve all disputes arising out of or relating
to this MOU through arbitration, after exhausting applicable administrative review, to the
extent required by A.R.S.§ 12-1518(B) and except as may be required by other applicable
statutes. See Attachment 4.
6. CONFLICT OF INTEREST: The requirements of A.R.S. § 38-511 apply to this MOU. Any
party may cancel this MOU, without penalty or further obligation, if a conflict exists pursuant
to A.R.S. § 38-511. See Attachment 5.
7. NON-DISCRIMINATION: To the extent required by law, all parties shall comply with
Executive Orders 2009-09, 2023-01, 2023-09C and all other applicable Federal and State laws,
rules and regulations including the Americans with Disabilities Act. See Attachment 6.
8. AUDIT OF RECORDS: Pursuant to A.R.S. § 35-214 and § 35-215, all parties shall retain all
data, books and other records ("records") relating to this MOU for a period of five years after
completion of the MOU. All records shall be subject to inspection and audit by the State of
Arizona at reasonable times. Upon request, either party shall produce the original of any or all
such records. See Attachments 7 and 8.
9. NON-AVAILABILITY OF FUNDS: In accordance with ARS § 35-154, every payment
obligation of the State under the Agreement is conditioned upon the availability of funds
appropriated or allocated for payment of such obligation. If funds are not allocated and available
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for the continuance of this Agreement, this Agreement may be terminated by the State at the
end of the period for which funds are available. No liability shall accrue to the State in the event
this provision is exercised, and the State shall not be obligated or liable for any future payments
or for any damages as a result of termination under this paragraph. See Attachment 9.
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PARTICIPATING ENTITIES
IN WITNESS WHEREOF, the entities below have caused this MOU to be executed by their
respective representatives duly authorized so to do as of the date below. Signatures contained on
this document acknowledge the participation by the represented entities and affirmation that the
represented agencies and all members will adhere to this MOU to the best of their ability.
City of Avondale, Avondale Police Department/Southwest Family Advocacy Center
Ron Corbin, City Manager
Date
City of Goodyear, Goodyear Police Department
Wynette Reed, City Manager
Date
City of Buckeye, Buckeye Police Department
Doug Sandstrom, City Manager
Date
Maricopa County, Maricopa County Sheriff’s Office
Sheriff’s Department Representative
Date
Department of Child Safety Representative:
Katie Ptak, DCS Director
Date
see attached MCSO signature page
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Maricopa County Attorney’s Office Representative:
Rachel Mitchell, Maricopa County Attorney
Date
Phoenix Children’s Hospital Representative:
Signature
Date
HonorHealth Representative:
Signature
Date
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Maricopa County Sheriff’s Office
________________________________________
Jerry Sheridan, Sheriff
Date
Maricopa County Board of Supervisors
________________________________________
Kate Brophy McGee,
Date
Chair of the Board
ATTEST:
________________________________________
Juanita Garza,
Date
Clerk of the Board
IN ACCORDANCE WITH A.R.S. §11-952 THIS CONTRACT HAS BEEN
REVIEWED BY THE UNDERSIGNED WHO HAS DETERMINED THAT THIS
CONTRACT IS IN APPROPRIATE FORM AND WITHIN THE POWERS AND
AUTHORITY GRANTED TO EACH RESPECTIVE PUBLIC BODY.
________________________________________
Deputy County Attorney
Date
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ATTACHMENTS
ATTACHMENT 1:
Intergovernmental Agreement between Partnering
Agencies
ATTACHMENT 2:
Intergovernmental Agreement between Partnering
Agencies and Department of Child Safety
ATTACHMENT 3
National Children’s Alliance Standards Link
ATTACHMENT 4:
A.R.S.§ 12-1518
ATTACHMENT 5:
A.R.S.§ 38-511
ATTACHMENT 6:
Executive Order 2023-01 Protecting Employment Opportunity
ATTACHMENT 7:
A.R.S.§ 35-214
ATTACHMENT 8:
A.R.S.§ 35-215
ATTACHMENT 9:
A.R.S.§ 35-154
ATTACHMENT 1:
Intergovernmental Agreement between
Partnering Agencies
ATTACHMENT 2:
Intergovernmental Agreement between
Partnering Agencies and Department of Child
Safety
INTERGOVERNMENTAL AGREEMENT BETWEEN
THE CITY OF AVONDALE, THE CITY OF BUCKEYE, THE CITY OF GOODYEAR,
MARICOPA COUNTY
AND THE STATE OF ARIZONA
ACTING BY AND THROUGH DEPARTMENT OF CHILD SAFETY TO PROVIDE
INTEGRATED SERVICES TO CHILDREN AND FAMILIES
THIS INTERGOVERNMENTAL AGREEMENT (the "Agreement") is entered into on the date
of the last signature below, by and among the City of Avondale, an Arizona municipal corporation
("Avondale"), the City of Buckeye, an Arizona municipal corporation ("Buckeye"), the City of
Goodyear, an Arizona municipal corporation ("Goodyear") and Maricopa County, Arizona, an
Arizona municipal corporation, acting by and through the Maricopa County Sheriffs Office
("Maricopa") (collectively identified as the "Partnering Agencies") and the State of Arizona acting
by and through the Department of Child Safety, ("DCS") to provide integrated services to children
and families.
RECITALS
WHEREAS, DCS is duly authorized to execute and administer the Agreement under ARIZ. REV.
STAT.§ 8-453.
WHEREAS, DCS, Avondale, Buckeye, Goodyear and Maricopa have authority to enter into the
Agreement pursuant to ARIZ. REV. STAT.§ 11-952.
WHEREAS, the Partnering Agencies have entered into prior Intergovernmental Agreements with
respect to the operation of a domestic violence victim advocacy center located at 2333 N. Pebble
Creek Parkway, Suite A-200 (the "Center") for the provision of services to and for child and adult
victims of physical abuse, sexual abuse and domestic violence. ("Center IGA").
WHEREAS, in the Center IGA, the Partnering Agencies have agreed with respect to the operation
of Center that Avondale shall be the day-to-day manager of the Center. As the day-to-day
manager, Avondale shall be responsible for office and facility related concerns.
WHEREAS, the Partnering Agencies desire to participate in the shared use of the Center with
DCS to provide on-site agency collaboration through the use of multi-disciplinary team approach
for the prevention, investigation, assessment, protection, treatment and referral for prosecution of
matters related to the sexual and physical abuse of children and adults including domestic violence
matters (the "Services).
WHEREAS, DCS desires to participate in the shared use of the Center to promote the safety, well
being and self-sufficiency of children, adults and families to further its vision that every child,
adult and family in the State of Arizona will be safe and economically secure.
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DCS Southwest Family Advocacy Center
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DCS Southwest Family Advocacy Center
STATE OF ARIZONA DEPARTMENT OF CHILD SAFETY
By:___________________________________________
Name:_________________________________________
Title:__________________________________________
Date:__________________________________________
CERTIFICATION BY LEGAL COUNSEL
In accordance with the requirements of ARIZ. REV. STAT. § 11-952(D), the undersigned
Attorney acknowledges that (i) she/he has reviewed the above Agreement on behalf of her/his
client and (ii) as to her/his client only, has determined that the Agreement is in proper form and is
within the powers and authority granted under the laws of the State of Arizona.
___________________________________________,
Assistant Attorney General
ATTACHMENT 3:
NCA's National Standards of Accreditation -
National Children's Alliance
(nationalchildrensalliance.org)
FRONT COVER
National Standards
of Accreditation
for Children’s Advocacy Centers
2023 EDITION
This project was supported by grant #2018-CI-FX-K002 awarded by the Office
of Juvenile Justice and Delinquency Prevention, Office of Justice Programs,
U.S. Department of Justice. The opinions, findings, and conclusions or
recommendations expressed in this project are those of the presenters and do
not necessarily reflect those of the Department of Justice.
Table Of Contents
Introduction
4
Contributors
8
Standards
01. Multidisciplinary Team Standard
13
02. Diversity, Equity and Access of Services Standard
21
03. Forensic Interview Standard
25
04. Victim Support and Advocacy Standard
31
05. Medical Evaluation Standard
37
06. Mental Health Standard
43
07. Case Review and Coordination Standard
49
08. Case Tracking Standard
53
09. Organizational Capacity Standard
57
10. Child Safety and Protection Standard
63
Medical Appendix
67
Guiding Principles
Purpose of the Standards for Accredited
Members:
The Standards for Accreditation for Children’s
Advocacy Centers represent the evidence-
supported core competencies of the Children’s
Advocacy Center (CAC) model. They are
explicitly developed, revised, and guided by
the diverse ways in which CACs are organized,
sponsored, structured, staffed, resourced, and
housed in accordance with the unique factors
in their respective communities. Moreover, the
Standards are explicitly developed with values
of diversity, equity, and inclusion in mind.
With continued growth in CACs throughout
the United States, the Standards also seek to
balance the goal of serving greater numbers
of children and families with the critical need
to sustain the integrity of the CAC model
and its associated professional credibility.
Furthermore, National Children’s Alliance
(referred to hereafter as NCA) is committed
to ensuring a fair, transparent, and equitable
review process that recognizes the Standards
as minimum standards of operation that are
evidence supported, measurable, reviewed,
and revised over time as research progresses
and service needs evolve. In making the
Standards measurable and the basis of
measurement clear, NCA promotes the field’s
recognition of the importance the Standards
have for ensuring the delivery of high-quality,
relevant, and accessible services to children
and families served by CACs.
The Standards help ensure that all children
across the U.S. served by Children’s Advocacy
Centers receive consistent evidence-based
and evidence-supported interventions that
help them pursue safety, healing, and justice.
In addition, the Standards also have several
secondary purposes:
1.
to serve as a valuable roadmap for new
CACs as they develop;
2. to assist existing CACs in improving their
services to children and families;
3. to demonstrate the high-quality work of
Accredited CACs to stakeholders; and
4. to provide a compass to guide CACs,
MDTs, boards, and other stakeholders in
strategic planning and through leadership
transitions.
It is important to note that there is no
hierarchy among the National Standards for
Accreditation—all are equally important to the
healthy functioning of a Children’s Advocacy
Center. Therefore, the order in this Standards
document is not a rank ordering of importance.
Careful attention should be given by CACs to
each Essential Component, as they serve as a
ladder of success to the Standard as a whole.
PAGE 4 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Standards Revision Process
NCA’s Standards for Accredited Members
are reviewed through a process coordinated
by the Accreditation Department every five ,
consistent with the five-year period after which
reaccreditation is required. NCA conducts
regular reviews of the current Standards to
ensure that they reflect relevant advances
in evidence-based practices and are clear,
concise, and set at appropriate thresholds.
The first step of the process was the
commission and publication by NCA of the
Annotated Bibliography of the Empirical and
Scholarly Literature Supporting the Standards
for Accredited Members (hereafter referred to
as the “Annotated Bibliography”). It was first
published in 2011, reviewed and republished
in the 2013 second edition and, most recently,
reviewed and republished again in a 2019 third
edition. (Relevant research published in the
interim period was reviewed and added to the
draft bibliography.) Research support for all
existing standards was identified, providing
good evidence that the existing standards and
extant research were in alignment and pointed
in new areas in which an evidence base has
now developed.
In addition to the 10 core CAC National
Standards, and based on feedback from the
field, NCA’s Board of Directors directed the
Standards revision process to determine
whether sufficient evidence existed to establish
practice standards and guide CAC services in
Commercial Sexual Exploitation of Children
(CSEC), Prevention, and Physical Abuse. Since
every CAC does not provide these services,
and yet practice standards are needed for
those that do, the NCA Board determined
that these three new standards will guide CAC
services in these key areas at the discretion of
the individual CAC seeking accreditation or
reaccreditation. This means that these three
Standards may be included in the review
of site reviewers and CACs must opt-in for
such additional review. These topic areas
are included in the 2019 third edition of the
Annotated Bibliography.
Beginning in July 2020, NCA conducted
a stakeholder survey of Accredited CAC
members, accreditation site reviewers,
Regional CAC leaders, State Chapter directors,
and NCA Board members and staff seeking
feedback on the existing Standards as well as
requesting input on additional areas of inquiry.
During this time, the NCA’s Accreditation
Department also reviewed accreditation
outcome and evaluation data from the period
between January 2017 and June 2020 to
identify areas requiring further inquiry or
clarification.
During the summer of 2020, NCA hired
two independent consultants to review the
current Standards for Accreditation through a
diversity, equity, and inclusion (DEI) lens. They
each made DEI-relevant recommendations
for each of the current Standards and their
corresponding essential components, which
were shared throughout the rest of the revision
process.
After the collection, review and approval of
the final bibliography and the outcome and
evaluation data, the Accreditation Committee
convened seven Standards Task Forces to
examine the following individual or groupings
of related standards:
1.
Organizational Capacity, Case Tracking,
and Child Safety and Protection (formerly
Child-Focused Setting);
2. Multidisciplinary Team, Case Review and
Coordination (formerly Case Review), and
Forensic Interview;
3. Equity, Access, and Inclusivity of Services
(formerly Cultural Competency & Diversity)
and Victim Services & Advocacy;
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 5
Accreditation Process
CACs applying for new accreditation
or reaccreditation begin by filling out a
comprehensive application detailing how the
center meets each Standard. This application
must include the required documentation that
demonstrates how it meets the Standards.
NCA staff then screen the application for
completeness and provide it to a two-person
site review team. The two site reviewers will
review the application, contact the CAC
director, and send any questions or requests
for additional information before the scheduled
site visit.
The two-person site review team will conduct
an on-site or virtual review within six months
of submission of the application. The site
review will include a meeting with board
members, staff, and MDT members to review
practices and documentation that demonstrate
compliance with the Standards. Based upon
their findings, the site review team completes
a scoring form and makes a recommendation
regarding the CAC’s accreditation status.
NCA’s Accreditation Department reviews
pending status recommendations, which
occur when the CAC is deemed to have had
4. Medical Evaluation and Physical Abuse;
5. Mental Health;
6. Prevention; and
7.
Commercial Sexual Exploitation of Children
(CSEC).
Each Task Force was composed of subject
matter experts and representatives from
Regional CACs, Chapters, NCA member
CACs, NCA site reviewers and NCA senior
staff. Special care was taken to ensure that
each Task Force included representatives
who are experienced with CACs of diverse
organizational structure, caseload, geography,
and service population size and demographics.
Each Task Force member also participated in
a required implicit bias training prior to the
first meetings held in October 2020. Each
Task Force met monthly to discuss proposed
revisions to their assigned Standards,
completing this work in the spring of 2021.
A final review period of the full set of revisions
was conducted in spring of 2021 by a Readers’
Pool selected from across all seven Task
Forces. Feedback from the Readers’ Pool
and a DEI consultant was reviewed by NCA’s
Accreditation Department and senior staff.
The final draft version of the revised Standards
was submitted to NCA’s Executive Committee,
which reviewed it in May 2021 for any final
revisions. It was then submitted to the full
Board of Directors for a vote at their June
2021 meeting. At that time, the 2023 Edition
of the Standards for Accredited Members was
approved, and it was subsequently announced
at NCA’s 2021 Leadership Conference. This
allows a number of months for CACs to
complete their accreditation process before
the revised Standards become effective for all
CACs on January 1, 2023.
All CACs seeking accreditation for the first
time, whether applying as a brand-new center
or as a center in another membership category,
will be reviewed and evaluated based on the
Standards in effect during the year in which
they apply. Accredited Centers will continue
to need to engage in reaccreditation every
five years on a rolling basis from their previous
accreditation.
PAGE 6 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
deficits in one or more of the Standards. NCA’s
Board of Directors reviews the findings and,
if in agreement, approves the site reviewer
recommendations and awards accreditation.
Centers are notified of the outcome of the
review process at this time.
CAC’s who are accorded pending status
are given a one-year period to implement
and document a corrective action plan that
demonstrates compliance. At the end of this
pending period, the corrective action plan
documentation is reviewed by the original two
site reviewers, the Accreditation Department,
and NCA’s Board of Directors. The Board
makes the final determination regarding
compliance and either awards or denies
accreditation accordingly. Centers denied
accreditation have the option to appeal the
denial decision or begin a new accreditation
process.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 7
Name
Employer
Abbie Newman, JD
Mission Kids Child Advocacy Center
Adebimpe Adewusi, MD
CARES Northwest
Althea Miller
Harford County Child Advocacy Center
Amelia Siders, Ph. D.
Children's Advocacy Centers of Michigan
Amy Russell, JD
Arthur D. Curtis Children's Justice Center
Antoinette Laskey, MD
University of Utah, Primary Children's Hospital
April Leming
Children's Advocacy Centers of Texas
Betti Mucha
Perry-Jackson Child Advocacy Center
Billie Larkin
NCA Site Reviewer
Brenda George
Children's Alliance of Montana
Caitlin Bentley
Ohio Network of Children's Advocacy Centers
Caitlin Massey
Strafford County Child Advocacy Center
Cameo Stanick
Hathaway-Sycamores Child and Family Services of Los Angeles
Carole Swieckie
Dee Norton Child Advocacy Center
Carrie Little
Children's Advocacy Centers of Oklahoma
Cathy Brittis
CAC at Children's Hospital at Dartmouth
Channing Petrak, MD
Pediatric Resource Center
Char Rivette
Chicago Children's Advocacy Center
Charles Wilson
Consultant
Chelsea Churchill
Children's Advocacy Centers of Texas
Chris Kirchner
Children's Advocacy Centers of Pennsylvania
Chris Newlin
National Children's Advocacy Center
Claudnyse Holloman
Voices for Children Advocacy Center
Corey Brodsky
Midwest Regional Children's Advocacy Center
Crimson Barocca
Baltimore Child Abuse Center
Dana Sawyer
Western Regional Chidlren's Advocacy Center
Darby Geller
SAFE Center
David Finkelhor, Ph. D.
Crimes against Children Research Center, University of New
Hampshire
Deana Joy
Children's Advocacy Centers of North Carolina
Contributors
PAGE 8 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Name
Employer
Debra Poole, Ph. D.
Central Michigan Univeristy
Diana Schunn
Child Advocacy Center of Sedgwick County
Dominic Prophete, JD
Wynona's House Child Advocacy Center
Dr. Trinity Ingram-Jones
The Cottage
Eileen Caraker
Gloucester County Children's Advocacy Center
Elizabeth LeTourneau, Ph. D.
Johns Hopkins University
Ellen Morrissey
Children's Advocacy Centers of Texas
Ernestine Briggs-King, Ph. D.
Duke University
Gene Klein
Project Harmony
Greg Flett
Southern Regional Children's Advocacy Center
Isha Metzger, Ph. D.
University of Georgia, The EMPOWER Lab
Jane Braun
NCA Site Reviewer
Janet Fine
NCA Site Reviewer
Jasmine Mau-Mukai
Hawaii State Chapter of Children's Justice Centers
Jeffrey Wherry, Ph. D.
UT Health Science Center at Tyler
Jessica Miller
The Gingerbread House
Johanna Hager
Braveheart Children's Advocacy Center
John Pizzuro
Commander New Jersey State Police
Jordan Benning
Midwest Regional Children's Advocacy Center
Joyce Moran
Southern Virginia Child Advocacy Center
Julie Porterfield
Emerald Coast Children's Advocacy Center
Julie Stauffer
CornerHouse
Karen Farst, MD
University of Arkansas for Medical Sciences
Karen Hangartner
Southern Regional Children's Advocacy Center
Karla Tye
Children's Advocacy Centers of Mississippi
Kasey Jackson
Children's Advocacy Centers of Texas
Kathryn Flack
West Virginia Child Advocacy Network
Katie Connell
Federal Bureau of Investigations
Kelly DaCunha
Baltimore Child Abuse Center
Kelly Kinnish
Georgia Center for Child Avocacy
Kimberly Mangiaracino
Children's Advocacy Centers Of Illinois
Kori Stephens
Resonance Rising
Kristy Brodeur Dermody
CALICO Center, Children's Advocacy Centers of California
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 9
Name
Employer
Laura Gapske
First Witness Child Advocacy Center
Laura Ng
Chicago Children's Advocacy Center
Leigh Bolin
Resource Center for Parents & Children
Libby Nicholson
CARE House
Libby Ralston
Dee Norton Child Advocacy Center
Linda Cordisco Steele
National Children's Advocacy Center
Lindsay Jordan
Children's Advocacy Centers of Texas
Lisa Conradi
The Chadwick Center at Rady Children's Hospital
Lori Frasier, MD
PinnacleHealth Children's Resource Center
Luis Acuna-Pilgrim
Children's Advocacy Centers of Texas
Marcia Milliken
Minnesota Children's Alliance
Mark Hudson, MD
Midwest Regional Children's Advocacy Center
Maureen Fitzgerald
Children's Advocacy Centers of Washington
Maureen O'Connell
Midwest Regional Children's Advocacy Center
Melissa Brunner
Southern Regional Children's Advocacy Center
Melissa Ewer
New Mexico Children's Alliance
Melissa Snow
National Center for Missing & Exploited Children
Michele Mullen
Northeast Regional Children's Advocacy Centers
Michelle Thames
SafeSpot Children's Advocacy Center
Nydia Monagas, Psy. D.
New Jersey Children's Alliance
Pam Karalunas
NCA Site Reviewer
Patti Terzian
Western Regional Children's Advocacy Center
Paul DiLorenzo
Philadelphia Children's Alliance
Paula Condol
Dakota Children's Advocacy Center
Peter Boser
New Jersey Children's Alliance
Rachel Niemiec
Massachusetts SANE Program/Norfolk Advocates for Children
Regan Stewart, Ph. D.
Medical University of South Carolina
Rita Farrell
Zero Abuse Project
Ruby Nelson
Prince Georges County Department of Social Services Child
Advocacy Center
Sabina Alic
Nebraska Alliance of Children's Advocacy Centers
Salli Kerr
Western Regional Chidlren's Advocacy Center
Sara Lee
Midwest Regional Children's Advocacy Center
PAGE 10 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Name
Employer
Sarah Forrest
Nebraska Alliance of Children's Advocacy Centers
Shawna Pagano
Pat's Place Child Advocacy Center
Stacie LeBlanc, JD
The Up Institute - APSAC
Sue Ascione
Northeast Regional Children's Advocacy Center
Susan Goldfarb
Children's Advocacy Center of Suffolk County
Suzanne Starling, MD
The Chadwick Center at Rady Children's Hospital
Tammi Pitzen
Children's Advocacy Center of Jackson County
Ted Cross, Ph. D.
The Children & Family Research Center, University of Illinois
Teresa Smith, Ph. D.
Northeast Regional Children's Advocacy Centers
Terri Covington
Consultant
Tifanie Petro
Children's Home Child Advocacy Center
Tina Morgan
NCA Site Reviewer
Tom Knapp
South Carolina Network of Children's Advocacy Centers
Tomiko D. Mackey
Family Crisis Services of Northwest Mississippi
Tony DeVincenzo
Northeast Regional Children's Advocacy Center
Tracey Tabet
Utah Children's Justice Centers
Vickie Melvin
Philadelphia Children's Alliance
Vicky Gwiasda
Western Regional Chidlren's Advocacy Center
Victor Vieth, JD
Zero Abuse Project
Wendy Lane, MD
Baltimore Child Abuse Center; Howard County Child Advocacy
Center
Wendy Loomis
Child First Advocacy Center
Teresa Huizar
National Children's Alliance
Kim Day
National Children's Alliance
Kristie McKenney
National Children's Alliance
Alyson MacKenzie
National Children's Alliance
Alyssa Todd
National Children's Alliance
Blake Warenik
National Children's Alliance
Michelle Miller, Ph. D.
National Children's Alliance
Jan Lutz
Indiana Chapter of National Children's Alliance
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 11
PAGE 12 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
01. Multidisciplinary Team
Standard 01
Multidisciplinary
Team
A multidisciplinary team response to child abuse
allegations includes representation from the following:
• Law enforcement
• Child protective services
• Prosecution
• Medical
• Mental Health
• Victim Advocacy
• Children’s Advocacy Center
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 13
01. Multidisciplinary Team
Rationale
A committed and effective multidisciplinary
team (MDT) with a shared common goal is the
foundation of a Children’s Advocacy Center
(CAC). An MDT is a group of professionals
from specific and distinct disciplines that
collaborates from the point of report and
throughout a child and family’s involvement
with the CAC. MDTs coordinate investigations
and service delivery to mitigate potential
trauma to children and families, to keep open
the lines of communication and maintain
transparency and foster trust, and to help
optimize a quality response overall, while
preserving and respecting the rights of the
clients, and the mandates and obligations of
each agency.
A CAC is an agency or organization that
facilitates the interagency coordinated
response. All MDT representatives contribute
their knowledge, experience and expertise for
a coordinated, comprehensive, compassionate
response that is relevant and accessible to its
clients. Quality assurance and a review of the
effectiveness of the MDT’s collaborative efforts
are also critical aspects of the MDT response.
The core MDT must be composed of
representatives from law enforcement, child
protective services, prosecution, medical
providers, mental health providers, victim
advocates, MDT leadership, and CAC staff.
CAC staff may provide any of the above
functions, or additional functions, such as
forensic interviewers. Some CACs, including
those in small or otherwise under-resourced
rural communities, may employ one person
to fill multiple roles. For example, the
CAC director may also serve as the victim
advocate, or a CPS worker may function as a
forensic interviewer and a caseworker. What
is important is that clear boundaries are
maintained between each function, and that
the MDT response is inclusive of and utilizes
all of the required functions outlined in these
Standards.
MDTs may be expanded to include
professionals with other relevant roles and
responsibilities, including guardians ad
litem, adult and juvenile probation officers,
dependency (civil) attorneys, out-of-home
care licensing personnel, federal investigators,
school personnel, domestic violence providers
and others as deemed necessary and
appropriate for an individual child, family or
community on a case-by-case or routine basis.
Generally, a coordinated MDT approach results
in efficient interagency communication and
information sharing, ongoing collaboration of
key individuals, and a network of support for
children and families. Each agency benefits
from the knowledge and expertise of MDT
colleagues, thorough and shared information,
and improved and timely gathering of
evidence that guide individual and collective
interventions and help ensure the most
efficacious outcomes for the clients and all
of the MDT partners. CACs function within
a trauma-informed framework designed
to reduce harm and support healing. MDT
interventions in a neutral, child-focused
CAC setting are associated with clients
experiencing less anxiety, having to undergo
fewer interviews, and seeing more appropriate
and timely referrals for needed services
and meaningful participation by clients in
the protective services, criminal justice, and
other systems where applicable. In addition,
a coordinated MDT response can empower
parents and other caregivers to protect and
support their children throughout the life of the
case and beyond.
01. Multidisciplinary Team
PAGE 14 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
01. Multidisciplinary Team
BENEFITS OF THE MDT
APPROACH BY MDT FUNCTION
Law Enforcement
•
May generate additional evidence to create
a stronger case that is less reliant on only
the victim’s disclosure.
•
Support and advocacy functions are
attended to by other MDT partners, leaving
law enforcement personnel more time to
focus on their investigatory role.
•
Enhanced collaboration between
investigative partners results in a better
understanding of family dynamics and
improved response to child protection
issues.
CPS
•
Contributes historical family information,
which enhances MDT’s abilities to
foster child safety and provide parental
support and assistance with service
plans, minimizing need for escalated CPS
interventions.
•
Provides additional support and
intervention in cases where safety cannot
be assured.
Medical Providers
•
History and other information obtained
during the coordinated forensic interview
prevents unnecessary duplication of effort
and guides medical decisions.
•
Provide consultation on specialized medical
evaluations and interpretation of medical
findings and reports.
Mental Health Providers
•
Contribute valuable information to the
MDT regarding the child’s emotional
state, treatment, and other service needs,
and are able to participate in the criminal
justice process and other systems where
necessary.
•
Help ensure that trauma-informed and
culturally relevant assessment, treatment,
and related services are routinely made
available and accessible to children and
families.
Victim Advocates
•
Provide crisis assessment and intervention,
safety planning, referrals for additional
services, ongoing support, information and
case updates, and court advocacy where
necessary in a timely manner.
•
Help ensure the MDT’s ability to anticipate
and respond effectively to the specific
needs of children and their families; lessen
the stress of, and afford legal rights and
meaningful participation in, various systems
and the court process; and increase
access to services and resources for the
child and family, including crime victims’
compensation.
Prosecutors
•
Provide information about the criminal
justice process, victim rights, and seek
input from children and families to inform
decisions.
•
Integrate input from MDT members
to optimize ability to hold offenders
accountable and ensure community safety.
Children’s Advocacy Center
•
Coordinates the MDT response to ensure
the child and family are receiving non-
duplicative services.
•
Offers a child-focused setting where
trained professionals conduct forensic
interviews and other needed services are
provided.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 15
01. Multidisciplinary Team
Essential Component A:
The MDT Coordinator/Facilitator coordinates
and facilitates the day-to-day information
sharing and activities of the MDT. The MDT
facilitator/coordinator must complete training
that includes a minimum of eight hours
of instruction. (This may be the same or
different from the person who facilitates
case review sessions, as some case reviews
are facilitated by MDT members.)
Training topics which cover the function of the
MDT Coordinator/Facilitator may include:
•
Developing and maintaining relationships
with and among MDT members
•
Defining roles and responsibilities of team
members
•
Defining mission, vision, and values of the
MDT
•
Managing change and turnover on the
MDT
•
Navigating and resolving conflict
•
Knowledge of evidence-informed team
development models
•
Facilitating shared decision-making
•
Ensuring adherence to MDT agreements
and protocols
•
Understanding of the various meeting
structures that support effective teams
•
Facilitating effective communication
processes
•
Creating psychological safety
•
Training in implicit bias and how it impacts
the MDT
•
Building resilience for the MDT
STATEMENT OF INTENT
The person designated to coordinate and
facilitate the MDT should have training
experience in team facilitation to ensure a
fully inclusive and participatory process that
will ultimately benefit the child client MDT
coordinators/facilitators may come from a
variety of professional backgrounds. Often
they have subject matter expertise in child
abuse, child abuse investigations, or other
human services occupations. However,
facilitating a team of multidisciplinary
professionals is a unique skill set. It requires
an understanding of group dynamics, conflict
resolution techniques, and team problem-
solving. This requires specialized training in
order to set the MDT Facilitator/Coordinator up
for success. The MDT Facilitator/Coordinator
may be a person employed by the CAC
who has another role in addition (such as an
Executive Director, forensic interviewer, or
victim advocate) or may exclusively act as the
MDT Coordinator/Facilitator. In some CACs
this person also facilitates case review. In
others, an MDT member may facilitate case
review while the MDT Coordinator/Facilitator
is responsible for coordinating day to day
information-sharing. However, it is constructed
the CAC must be able to identify this role,
who fills, it and the role must be viewed by the
team as the go-to by MDT members for case
coordination, information-sharing among team
members, and addressing team functioning.
The CAC employee who fills this role must
have the required baseline training. In the rare
instance in which someone outside the CAC
plays this vital role, the training requirement
does not apply (though is highly encouraged).
Essential Component B
The designated MDT facilitator must
demonstrate participation in continued
education in the field of child maltreatment
and/or facilitation for a minimum of eight
contact hours every two years.
STATEMENT OF INTENT
The CAC must provide ongoing opportunities
for the MDT facilitator/coordinator employed
by the CAC to receive ongoing training. It is
important that team facilitators remain current
PAGE 16 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
01. Multidisciplinary Team
on developments in facilitation and other
relevant fields of practice to further enhance
their expertise.
Essential Component C
The CAC/MDT has, and facilitates, a
written interagency agreement signed
by authorized representatives of all MDT
members that clearly commits the signed
parties to its collaborative multidisciplinary
response to reports of child abuse and the
needs of children and families it serves. The
interagency agreement must include:
1. Law enforcement
2. Child protective services
3. Prosecution
4. Mental health
5. Medical
6. Victim advocacy
7. Children’s Advocacy Center
STATEMENT OF INTENT:
Written agreements formalize commitment to
the overall CAC mission and goals, interagency
cooperation and collaboration, and adherence
to CAC/MDT policies ensuring consistent, high
quality, trauma-informed and culturally relevant
practice. Whether written agreements are
referred to as memoranda of understanding
(MOUs) or interagency agreements (IAs), or
something else, they must be signed by the
leadership of participating agencies (e.g.,
police chiefs, prosecuting attorney, agency
directors or department heads, supervisors,
etc.) or their authorized designees. These
documents should be developed with input
from the MDT, reviewed annually, and revised
and re-executed when necessary to reflect
changes in leadership/signatories, practice, or
policy.
Essential Component D
Written protocols and/or guidelines address
the functions of the MDT, the roles and
responsibilities of each discipline/role and
their interaction with the CAC throughout
the life of the case, including the role of the
MDT facilitator/coordinator. Protocols are
developed with input from the MDT, updated
and signed by all MDT partner agencies
minimally every three years. The protocols
should be reviewed annually and updated as
needed to reflect current practice between
three-year signing cycles.
STATEMENT OF INTENT:
The active involvement and commitment
of all of the MDT agency leaders and their
representatives are critical to ensuring that the
policies and protocols by which investigations
are conducted and services provided are
consistently followed.
Essential Component E
All core members of the MDT, including
appropriate CAC staff, are routinely and
actively involved in investigations, case
management and/or MDT interventions
throughout the life of the case, in accordance
with the defined needs of children and
families and the case.
STATEMENT OF INTENT:
The purpose of multidisciplinary involvement
for all interventions is to assure the unique
needs of children and families are assessed
and addressed. Coordination and collaboration
among MDT members allow for informed
decision-making to occur at all stages of the
case to ensure optimal benefit to children and
families. Multidisciplinary intervention begins
at initial report and includes, but is not limited
to, child protection and/or law enforcement
response, forensic interviews, pre- and post-
forensic interview meetings, consultations,
advocacy, medical and mental health
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 17
01. Multidisciplinary Team
screening, assessment and treatment, referrals
for other services, case review and possible
prosecution.
Essential Component F
CAC/MDT members participate in effective
information sharing that is consistent with
legal, ethical, and professional standards of
practice and ensures the timely exchange of
case information within the MDT.
STATEMENT OF INTENT:
Regular and effective communication and
information sharing minimizes duplicative
efforts, enhances decision-making, and
maximizes the opportunity for children and
families to receive the services they need.
Understanding of issues of confidentiality
and privacy and relevant legal and ethical
obligations must be considered and respected.
Essential Component G
The CAC has written documentation
describing how information sharing is
communicated among MDT members and
how confidential information is protected.
STATEMENT OF INTENT:
Most professions represented on the MDT
have legal, ethical, and professional standards
of practice with regard to client privacy,
confidentiality and privileged communications.
The standards and requirements may differ
across disciplines. States may have relevant
laws in addition to the federal Health
Information Portability and Accountability Act
(HIPAA) that govern such practices. The CAC/
MDT must create written confidentiality and
information-sharing guidance that align to
these standards and specifically apply to the
MDT members, staff, and volunteers.
Essential Component H
The CAC provides routine opportunities
for MDT members to give feedback and
suggestions regarding procedures and
operations of the CAC/MDT. The CAC has a
formal process for reviewing and assessing
the information provided.
STATEMENT OF INTENT:
CACs should have both formal and informal
mechanisms for eliciting regular feedback
from MDT members regarding the operations
and administration of the CAC (e.g.,
transportation for clients, use of the facility,
equipment upgrades, etc.) and MDT issues
(e.g., communication, case decision-making,
documentation and record-keeping, conflict
resolution, training, etc.).
CACs should foster opportunities for
open communication in order to create an
atmosphere of trust and respect and to enable
MDT members to share responsibility for
enhancing the quality of the MDT response
with their ideas and concerns. Various methods
for eliciting feedback and/or suggestions from
MDT members may be utilized, including the
Outcome Measurement Survey (OMS) tool
team satisfaction survey, suggestion boxes and
MDT meetings specifically scheduled for this
purpose, among others.
Essential Component I
The CAC/MDT annually provides and/
or facilitates relevant training or other
educational opportunities focused on issues
relevant to investigation, prosecution,
and service provision to children and
their nonoffending caregivers. The CAC
demonstrates documented MDT member
participation in this annual professional
development.
PAGE 18 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
01. Multidisciplinary Team
STATEMENT OF INTENT:
Ongoing learning is critical to the successful
operation of CAC/MDTs. The CAC identifies
and/or provides relevant educational
opportunities for MDT members, including
topics that enhance the knowledge and skills
of MDT members, collaborative work across
disciplines and a deeper understanding of
each discipline’s role in service provision.
This may include directly providing training
to MDT members, sharing opportunities to
attend conferences, and/or online training
opportunities offered by the State Chapter,
Regional CACs, or state or national training
providers.
Essential Component J
The CAC/MDT provides formal orientation
for new MDT members regarding CAC/MDT
process, policies and procedures, and code of
conduct.
STATEMENT OF INTENT:
New MDT members arrive experienced in
their profession but often inexperienced
with multidisciplinary team principles and
practice. Providing an orientation for new
MDT members ensures that they understand
how the team functions, what is expected of
their role, and how each member of the team
contributes to the case and to better child
outcomes. Orienting team members well at the
beginning can reduce confusion and conflict
and contribute to better overall team function.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 19
02. Diversity, Equity, and Access
PAGE 20 •
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS
| 2023 EDITION
02. Diversity, Equity, and Access
Standard 02
Diversity, Equity,
and Access
The Children’s Advocacy Center provides culturally
responsive services for all CAC clients throughout the
duration of the case.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 21
02. Diversity, Equity, and Access
Rationale
Cultural responsiveness is the ability to
understand and consider different cultural
backgrounds of the clients to whom you
offer services. It also demonstrates the
capacity to learn from and relate respectfully
with people from both similar and different
cultural backgrounds, requiring the ability
to appreciate, understand and interact with
members of diverse populations within the
local community. Cultural responsiveness
is a fundamental component of the CAC
philosophy and is as central to operations
as developmentally appropriate, child-
focused, and trauma-informed practice. Like
developmental considerations, cultural norms
influence nearly every aspect of working with
children and families, such as welcoming a
child and family to the child advocacy center,
employing effective forensic interviewing
techniques, assessing the likelihood of abuse,
selecting appropriate mental health providers,
and securing services that are relevant and
accessible to a child and family. To effectively
meet clients’ needs, the CAC and MDT must
be willing and able to understand the clients’
worldviews, adapt practices as needed, and
offer assistance in a manner in which it can be
utilized. Striving toward culturally responsive
services is an important and ongoing endeavor
and an integral part of a CAC’s operations and
service delivery.
Proactive, culturally relevant planning and
outreach should focus on culture, experience of
acculturation, ethnicity, religion, socioeconomic
status, disability, gender, gender identity
and expression, and sexual orientation.
These factors contribute to a client’s lived
experiences and perspectives, and they must
be considered and accommodated throughout
the investigation, intervention, and case
management processes. Addressing these
factors in a culturally sensitive environment
helps children and families of all backgrounds
and experiences feel welcomed, valued,
and respected by staff, MDT members and
volunteers.
The CAC and its partners develop policies,
procedures and practices that are designed
to reduce disparities in access to services
and outcomes from services provided. The
CAC and MDT actively express values and
understanding of equity and inclusion and
those values are evident in practice.
Essential Component A
The CAC in, partnership with the MDT,
conducts a community assessment at a
minimum of every three years, which includes:
1. Community demographics
2. CAC client demographics
3. Analysis of disparities between these
populations
4. Methods the CAC utilizes to identify and
address gaps, disparities and/or inequities
in services
5. Strategies for outreach to unserved or
underserved communities, in alignment
with identified disparities
6. A method to monitor the effectiveness of
outreach and intervention strategies
STATEMENT OF INTENT:
In order to serve a community in a culturally
responsive manner, a CAC, in partnership
02. Diversity, Equity, and Access
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02. Diversity, Equity, and Access
with its MDT, must complete a comprehensive
assessment of the entire community and
jurisdiction they serve. The assessment should
focus on a range of issues, including, but not
limited to, race, ethnicity, gender, gender
identity and expression, sexual orientation,
disabilities, income, geography, religion, and
culture. The assessment should inform the
development of goals and strategies that
ensure the CAC delivers high-quality, relevant,
and accessible services to all children and
families in need.
Essential Component B
The CAC must ensure that provisions are
made for non-English-speaking and deaf
and hard-of-hearing children and their family
members throughout the investigation,
intervention, and case management
processes.
STATEMENT OF INTENT:
The ability to effectively communicate is critical
in creating an environment in which children
and families feel comfortable and safe and are
respected and supported. Language barriers
may hinder the ability for children and families
to understand the CAC and MDT process/
roles, and to communicate their concerns
and decisions regarding the investigation and
intervention services. Language barriers may
also compound children and families’ feelings
of fear, anxiety, and confusion. Language can
significantly impact the CAC and/or MDT’s
abilities to both share with, and obtain accurate
information from, the child and family. The
CAC must explore a variety of resources
or solutions to ensure adequate provisions
are made to overcome language and
communication barriers. In order to protect
the integrity of the investigation and services,
care should be taken to ensure appropriate
interpreters are utilized. CACs must not utilize
children or client family members to interpret
for MDT members.
Essential Component C
CAC services are accessible and tailored to
meet the various individualized and unique
needs of children and families throughout
the investigation, intervention, and case
management process.
STATEMENT OF INTENT:
It is the responsibility of the CAC and MDT
members to understand and tailor services to
the diverse backgrounds and unique needs
of the children and families being served.
Ascertaining the client’s background from the
client allows CAC/MDT members to better
understand child and family perceptions
of past and present abuse and trauma,
attributions of responsibility, and experience
of acculturation and comprehension of laws.
In addition, it allows the CAC/MDT to address
any religious or cultural beliefs that may affect
disclosure, needed services and access to
them, and to recognize the impact of prior
experience with police and government
authorities both in this country and in their
countries of origin. Furthermore, the CAC’s
investigation and case management services
must be accessible and responsive to children
with physical disabilities, cognitive delays, and
medical and mental health disorders. With
knowledge, preparation and necessary skills,
the MDT can obtain as complete and accurate
information as possible and more effectively
understand and respond to the child and
family’s needs.
Essential Component D
The CAC demonstrates ongoing efforts
through formal policies, procedures and
practices to recruit, hire, and retain staff,
volunteers, and board members who reflect
the demographics of the community.
STATEMENT OF INTENT:
Actively seeking to recruit, hire, and retain
staff, volunteers, and board members who
reflect the demographics of the community
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 23
02. Diversity, Equity, and Access
and the clientele served is critical to achieving
an overall response to children and families
that is inclusive, relevant, and effective.
Essential Component E
The CAC values Diversity, Equity, and
Inclusion (DEI) and requires CAC staff to
participate in DEI training a minimum of eight
hours every two years.
Examples of training topics could include:
•
Implicit bias
•
Microaggressions
•
Organizational learning
•
Building a culture of inclusion
•
Reducing disparities in services
STATEMENT OF INTENT:
Understanding and integrating issues
of diversity, equity and inclusion are not
accomplished in a single training. Valuing DEI
in all CAC activities requires an intentional,
ongoing, and evolving exploration of its
personal and professional meaning and
implications for how staff interact with, and
provide services and support to, clients and
communities with diverse backgrounds and
needs. Participating in this minimum number of
hours of training every two years demonstrates
a baseline commitment to ensuring that these
critical issues become part of the CAC staff’s
individual and collective responses to the
children, families, and communities they serve.
Essential Component F
The CAC values Diversity, Equity, and
Inclusion (DEI) and annually provides
MDT members access to DEI training and
information. The CAC documents training
opportunities (whether provided directly or
through access to other organizations) and
MDT participation.
Examples of training topics could include:
•
Implicit bias
•
Microaggressions
•
Organizational learning
•
Building a culture of inclusion
STATEMENT OF INTENT:
Understanding and integrating issues of
diversity, equity and inclusion into professional
practice are not accomplished in a single
training. Valuing DEI in all activities of MDT
members, both individually and collectively,
requires an intentional, ongoing, and evolving
exploration of the personal and professional
meaning of DEI and how it impacts the
accessibility of services and support to their
clients. Participating as a team in DEI training
helps demonstrate a baseline commitment
to these critical issues that enhance the
individual and collective responses to the
children, families, and communities that all
MDT members serve. Quality DEI training
and resources are offered through many
organizations. Many available online trainings
and other resources are available free of
charge. A good place to start is to ask your
State Chapter and/or Regional Children’s
Advocacy Center about available resources.
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03. Forensic Interview
Standard 03
Forensic
Interview
Forensic interviews are coordinated to avoid duplicative
interviewing and are conducted in a manner that is
legally sound and of a neutral, fact-finding nature.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 25
03. Forensic Interview
Rationale:
The purpose of CAC forensic interviews is to
facilitate information gathering from children to
determine whether abuse occurred and, if so,
the nature of the allegations. This information
is intended to contribute to accurate and fair
decision-making by the MDT members relative
to the criminal justice, child protection and
relevant service delivery systems. Forensic
interviews are conducted in a manner that is
developmentally and culturally responsive,
unbiased, fact-finding and legally sound.
When a child is unable to provide information
regarding any concern of abuse through the
forensic interview process, other interventions
to assess the child’s safety and well-being are
required.
The CAC/MDT must adhere to research-based
forensic interview guidelines that create an
interview environment that enables free recall,
minimizes interviewer influence, and gathers
information needed by all the MDT members
in order to avoid duplication of the interview
process. The CAC/MDT must monitor these
guidelines over time to ensure they reflect
current research-based practice, and CAC/
MDT protocols and practices need to be
congruent.
Forensic interviews are the foundation for
multiple CAC/MDT functions, including
child protection and criminal investigations,
prosecution, and implementation of services
critical to helping ensure children and families’
paths toward safety, healing, and justice. The
child’s experience during the initial forensic
interview may significantly impact the child’s
understanding of, and ability to respond to,
the ensuing steps in the various aspects of the
intervention process.
Skilled forensic interviewing by appropriately
trained individuals requires an appropriate
neutral setting and effective communication
among MDT members. While CACs vary with
regard to who conducts forensic interviews,
the role must be fulfilled by an appropriately
trained, qualified, supervised professional
who engages in peer review and ongoing
professional development. This may include
a CAC-employed forensic interviewer, law
enforcement officers (local, state, and/or
federal), CPS workers, or others determined by
the CAC/MDT in accordance with the resources
available in their respective communities. At
a minimum, any professional in the role of
a forensic interviewer must have initial and
ongoing formal forensic interviewer training
that is approved by National Children’s Alliance
(NCA) for purposes of accreditation. State laws
may also dictate which professionals can or
should conduct forensic interviews.
The CAC/MDT’s written documents must
include the general interview protocol,
guidelines for selecting an appropriately
trained interviewer, specifications for sharing
of interview information among MDT
members, and a mechanism for collaborative
case planning, peer review and continuing
education. Additionally, for CACs that conduct
Extended Forensic Evaluations, an additional
protocol for this purpose must also be
articulated.
Essential Component A
Forensic interviews are provided by MDT/CAC
staff with specialized training in conducting
forensic interviews.
The CAC must demonstrate that all forensic
interviewer(s) have successfully completed
03. Forensic Interview
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03. Forensic Interview
training that includes the following elements:
1. Minimum of 32 hours of instruction and
practice
2. Evidence-supported interview protocol
3. Pre- and post-testing that reflects
understanding of the principles of legally
sound interviewing
4. Child development; question design;
implementation of protocol; dynamics of
abuse; disclosure process; diversity, equity,
and inclusion; and suggestibility
5. Practice opportunities with a standardized
evaluation process
6. Required reading of current articles
specific to the practice of forensic
interviewing
Curriculum must be included on NCA’s
approved list of nationally or state-recognized
forensic interview trainings or submitted with
the accreditation application for review and
approval.
STATEMENT OF INTENT:
The CAC/MDT must have a process to ensure
initial forensic interview training for anyone
conducting a forensic interview at the CAC.
While MDT members may have received
general interview training, conducting forensic
interviews of children in the context of an MDT
response requires specialized training and
qualifications.
Essential Component B
Individuals who conduct forensic interviews
must demonstrate participation in ongoing
education in the field of child maltreatment
and/or forensic interviewing for a minimum of
eight contact hours every two years.
STATEMENT OF INTENT:
The CAC/MDT must provide ongoing
opportunities for professionals who conduct
forensic interviews to receive specialized
training. It is vitally important that forensic
interviewers remain current on developments
in forensic interviewing and other relevant
fields of practice to further enhance their
expertise.
Essential Component C
CAC/MDT forensic interview protocols must
reflect the following items:
1. Case acceptance criteria
2. Criteria for choosing an appropriately
trained interviewer (for a specific case)
3. Personnel expected to attend/observe
the interview on-site, specifically including
those with investigative responsibilities for
the case
4. Information sharing and communication
between the MDT and the forensic
interviewer before and after the interview
5. Use of interview aids
6. Use of interpreters
7. Recording and/or documentation of the
interview
8. Interview methodology (i.e., state- or
nationally recognized forensic interview
training models)
9. Introduction of evidence in the forensic
interviewing process
10. Sharing of information among MDT
members
11. A mechanism for collaborative case
coordination
12. Criteria and process for conducting a
multi-session or subsequent interview
13. The use of technology for remote live
observation of the forensic interview using
a secure method (if applicable)
14. The criteria and process for the use of
tele-forensic interviews (if applicable)
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 27
03. Forensic Interview
STATEMENT OF INTENT:
The forensic interview process must be
described in comprehensive detail in the
agency’s written guidelines or agreements.
These guidelines help ensure consistency and
quality of interviews, inform MDT discussions
pre-and post-interview, and support
subsequent decision-making. Technology now
makes it possible to both conduct and observe
(in real time) forensic interviews online and
remotely. Centers that wish to do either or both
should clearly identify in the written guidelines
or agreements the circumstances in which this is
allowed and the process for doing so. Children
who receive a tele-forensic interview must be
afforded the full range of CAC services and
MDT interventions as with any other clients.
Care must be taken that the use of remote
live observation does not result in the need
for repeated interviews or miscommunication
between team members. And any use of
remote live observation requires the team’s
written guidelines and agreements to outline
who may do so, and under what circumstances.
Essential Component D
The CAC allows for real-time observation of
forensic interviews by MDT members.
STATEMENT OF INTENT:
In order to create a psychologically safe space
and lessen or eliminate the need for duplicative
interviews, interviewers should be observed
by MDT members in a space other than the
interview room. The MDT should also have the
ability to communicate with the interviewer in
some manner to provide input and feedback
during the real-time interview with the child to
reduce the need for additional interviews.
Essential Component E
MDT members with investigative
responsibilities on a case must participate
in live/real-time observation of forensic
interviews to ensure necessary preparation,
information sharing and MDT/interviewer
coordination throughout the interview and
post-interview process.
STATEMENT OF INTENT:
MDT members, as defined by the needs of
the case, are present to observe the forensic
interview and participate in pre- and post-
interview discussions. This practice provides
MDT members with access to the information
necessary to fulfill their respective investigatory
and related professional roles. MDT members
who are present for forensic interviews typically
include local, state, federal or tribal child
protective services, and law enforcement;
others may vary based on the circumstances of
each case.
Essential Component F
Cases meeting the CAC case acceptance
criteria, as outlined in the MDT protocol, have
forensic interviews conducted at the CAC,
or through a secure tele-forensic method, a
minimum of 75% of the time.
STATEMENT OF INTENT:
Forensic interviews of children, as defined
in the CAC/MDT’s written protocols, will be
conducted at the CAC, where the MDT is best
equipped to meet the child’s needs during the
interview.
Written protocols must also address the rare
occasions when interviews may need to take
place outside the CAC with the agreed-upon
forensic interview guidelines utilized. Some
CACs have established interview rooms outside
of the primary CAC, such as at a satellite
office. In an alternate setting, MDT members
must assure the child’s comfort, privacy and
protection from alleged offenders and others
who may unduly influence the child. Remote or
tele-forensic interviews may also occur when
appropriate and/or necessary to increase access
and utilization of CAC forensic interviews. All
such alternatives must be agreed upon by the
MDT and codified in the written protocols. And
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03. Forensic Interview
any alternative must continue to afford child
clients the full range of CAC services.
CACs are encouraged to develop policies
that will provide the most comprehensive
services and benefits to all children in their
communities. Case acceptance criteria may
include various types of abuse, other forms of
direct or indirect exposure to violence/trauma,
jurisdictional issues, and the ages of children,
among others.
Essential Component G
Individuals who conduct forensic interviews
must participate in a structured forensic
interviewer peer review process a minimum
of two times per year. Peer review serves as a
quality assurance mechanism that reinforces
the methodologies utilized and provides
support and problem solving for participants.
Structured peer review includes:
1. Ongoing opportunities to network with,
and share learning and challenges with,
peers
2. Review and performance feedback on
actual interviews in a professional and
confidential setting
3. Discussion of current relevant research
articles and materials and implications for
forensic interview practice
4. Training opportunities specific to forensic
interviewing of children and CAC-specific
methodologies.
STATEMENT OF INTENT:
Participation in peer review is vital for quality
assurance of forensic interviewers and allows
for the further development and enhancement
of their skills based on new research and
developments in the field. Peer review is a
complement, not a substitute, for supervision,
as well as multidisciplinary case review and
case planning.
Essential Component H
The CAC/MDT coordinates information
gathering, including history taking,
assessments and forensic interview(s) to avoid
duplication.
STATEMENT OF INTENT:
All members of the MDT need information to
complete their respective assessments and
evaluations. Whether it is initial information
gathered prior to the forensic interview, history
taken by the medical provider, or intake by the
mental health or victim services provider, every
effort should be made to avoid unnecessary
duplication of information gathering from the
child and family members and ensure effective
information sharing among MDT members.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 29
04. Victim Support and Advocacy
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04. Victim Support and Advocacy
Standard 04
Victim Support
and Advocacy
Victim support and advocacy services are provided
to all CAC clients and their caregivers as part of the
multidisciplinary team response.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 31
04. Victim Support and Advocacy
Rationale:
Research demonstrates that parent/caregiver
support is essential to reducing trauma and
improving outcomes for children and family
members. Client access to, and participation
in, investigation, prosecution, treatment,
and support services are core components
of MDT response, and are informed and
supported by coordinated victim advocacy
services. Up-to-date information and ongoing
access to comprehensive services are critical
to a child and family’s well-being and ability
to participate in an ongoing investigation,
possible prosecution, intervention, and
treatment.
Victim support and advocacy responsibilities
are implemented consistent with legal and,
where relevant, state constitutional victims’
rights and the complement of services in the
CAC’s coverage area. Many members of the
MDT may advocate for children and families
within their discipline systems or agencies.
However, victim advocacy is a discipline
unto itself with a distinct and central role on
the MDT. Victim advocates provide services
and resources to ensure a consistent and
coordinated comprehensive network of
support for each child and family.
Children and families in crisis need assistance
in navigating the multiple systems involved
in the CAC response. More than one victim
advocate may perform these functions at
different points throughout a case, requiring
continuity and consistency in service
delivery. Coordination of victim support is
the responsibility of the CAC and must be
defined in the CAC/MDT’s written documents,
including understanding of relevant statutes
and ethics regarding confidentiality and
privilege. Specific victim support services may
be provided in a variety of ways, as dictated by
the needs of the CAC clients and case, such as:
•
Employing staff members with varying job
titles to perform advocacy functions (e.g.,
family advocates, care coordinators, victim
advocates and child life specialists, among
others)
•
Linking with local community-based
advocates, including, but not limited to
domestic violence advocates, rape crisis
counselors, Court Appointed Special
Advocates and advocates at culturally
specific organizations
•
Linking with system-based advocates
(e.g., law enforcement victim advocates,
prosecutor-based victim witness
coordinators)
•
Combining victim support services
depending upon the individual needs of
children and families
All advocates who serve on the MDT and
are providing services to CAC clients must
meet the prescribed training and supervision
requirements. This includes advocates on staff
at the CAC and/or advocates from outside
organizations providing advocacy services and
serving as members of the MDT.
Essential Component A
Comprehensive, coordinated victim support
and advocacy services are provided by
designated individual(s) who have specialized
training that includes a minimum of 24 hours
of instruction, including, but not limited to:
1. Dynamics of child abuse
2. Trauma-informed services
3. Crisis assessment and intervention
4. Risk assessment and safety planning
04. Victim Support and Advocacy
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04. Victim Support and Advocacy
5. Professional ethics and boundaries
6. Understanding the coordinated
multidisciplinary response
7. Understanding, explaining, and affording
of victim’s legal rights
8. Court education, support, and
accompaniment
9. Knowledge of available community and
legal resources, referral methods and
assistance with access to treatment and
other services, including protective orders,
housing, public assistance, domestic
violence intervention, transportation,
financial assistance, and interpreters,
among others as determined for individual
clients
10. Cultural responsiveness and addressing
implicit bias in service delivery
11. Caregiver resilience
12. Domestic violence/family violence/
children’s exposure to domestic violence
and poly-victimization
STATEMENT OF INTENT
Victim support and advocacy is fundamental
to the MDT response. These professional
support/advocacy responsibilities may be
filled by a designated victim advocate who is
an employee of the CAC or another victim-
serving agency. Another MDT member with
appropriate experience and training in victim
advocacy may also serve in this role; however,
in doing so, it must not conflict with the other
MDT functions they may have.
Essential Component B
Individuals who provide victim advocacy
services for the CAC must demonstrate
participation in ongoing education in the field
of victim advocacy and child maltreatment
consisting of a minimum of eight contact
hours every two years.
STATEMENT OF INTENT
The CAC and/or MDT must provide initial
and ongoing opportunities for professionals
who provide advocacy services to receive
specialized training and peer support. As with
all other disciplines represented on the MDT
and serving CAC clients, it is vitally important
that victim advocates remain current on
developments in fields relevant to their delivery
of services to children and families.
Essential Component C
Victim advocates serving CAC clients must
provide the following constellation of services:
1. Crisis assessment and intervention, risk
assessment and safety planning and
support for children and family members
at all stages of involvement with the CAC
2. Assessment of individual needs, cultural
considerations for child/family and help to
ensure those needs are being addressed
in concert with the MDT and other service
providers
3. Presence at the CAC during the forensic
interview in order to participate in
information sharing with other MDT
members, inform and support the
family regarding the coordinated,
multidisciplinary response, and assess
needs of children and nonoffending
caregivers
4. Provision of education and assistance
in ensuring access to victim’s rights and
crime victim’s compensation
5. Assistance in procuring concrete services
(housing, protective orders, domestic
violence intervention, food, transportation,
public assistance, civil legal services, etc.)
6. Provision of referrals for trauma-focused,
evidence-supported mental health and
specialized medical treatment, if not
provided at the CAC
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 33
04. Victim Support and Advocacy
7. Facilitating access to transportation to
interviews, court, treatment, and other
case-related meetings
8. Engagement with the child and family to
help them understand the investigation/
prosecution process and help ensure
understanding of crime victims’ rights
9. Participation in case review to
communicate and discuss the unique needs
of the child and family and associated
services planning; and help ensure the
coordination of identified services and that
the child and family’s concerns are heard
and addressed
10. Provision of case status updates to the
family, including investigations, court date,
continuances, dispositions, sentencing
and inmate status notification (including
offender release from custody)
11. Provision of court education and
support, including court orientation and
accompaniment
STATEMENT OF INTENT
While the particular combination of services
required will vary based upon the child
and family’s unique needs and the legal
requirements of any civil and/or criminal cases,
all children and families need support in
navigating the various systems they encounter
that are often unfamiliar to them. Crisis and
risk assessments and intervention, advocacy,
and support services will help to identify
the child and family’s unique needs, reduce
fear and anxiety, and expedite access to
appropriate services and resources. Families
can be assisted with crisis management,
including problem solving, access to critical
treatment and other services, and ongoing
education, information, and support. Crises may
recur with various precipitating or triggering
events, including, but not limited to, financial
hardships, child placement, arrest, change/
delay in court proceedings and preparation
for court testimony. Children may experience
crisis and trauma, including suicidal ideation,
at unanticipated times. Many CACs provide
advocacy services for children and their family
members on-site and/or through linkage
agreements with other community agencies or
system-based providers.
State and federal laws require that victims
of crime, including victims of child abuse,
are informed of their rights as crime victims,
including information about, and eligibility for,
crime victim compensation. Caregivers who
are affected by the crime are also entitled
to services and may be eligible for victim
compensation. Generally, children and their
families will be unfamiliar with their legal rights.
Therefore, information regarding rights and
services should be routinely and repeatedly
explained at the outset of their involvement
with the CAC/MDT and made available to all
children and their caregivers.
Essential Component D
Active outreach and follow-up support services
for caregivers consistently occurs.
STATEMENT OF INTENT
Often, families have never been involved in
this multi-system response, which can prove
intimidating and confusing. Active outreach
requires follow-up with families beyond initial
investigation, assessment, and crisis response.
Follow-up services after the initial contact at
the CAC must include ongoing, regular contact
until the CAC concludes its involvement with
the case.
In the aftermath of victimization, the child
and family typically feel a significant loss of
control. Education provides information that
is empowering. Victim education must be
ongoing and even repetitive as needed, as
families may be unable to process so much
information at one time, particularly in the
midst of a crisis. The family may be dealing with
immediate safety issues and may be coping
with the emotional impact of the initial report
and ensuing forensic interview and investigation
process. They may need a variety of concrete
medical, mental health, and social services.
As the case dynamics change, and as the case
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04. Victim Support and Advocacy
proceeds through the various systems, the
needs of the child and family will also change.
It is important that their needs continue
to be assessed, so that additional relevant
information, support, and services can be
offered and so that said services are accessed
and relevant.
Essential Component E
The CAC/MDT’s written protocols/
guidelines include availability of victim
support and advocacy services for all CAC
clients throughout the life of the case and
participation of victim advocate(s) in the MDT
case review. This participation must be in
accordance with legal requirements regarding
confidentiality.
STATEMENT OF INTENT
Because victim support/advocacy is a central
function of the CAC response, the availability
and provision of ongoing victim support and
advocacy by designated, trained individuals
must be included in the CAC/MDT’s written
documents. Service coordination, both within
and outside the CAC, must be clearly defined,
including the role of the victim advocate during
the interview process, follow-up, and case
review.
Essential Component F
Coordinated case management must occur
with all individuals providing victim advocacy
services to CAC clients.
STATEMENT OF INTENT
If multiple advocacy agencies share the
delivery of services, the CAC is responsible for
establishing protocols and linkage agreements
agreed upon by the MDT that clearly define
the victim advocacy roles and ensure seamless
coordination of victim advocacy services.
In any community or jurisdiction a CAC serves,
there may be various agencies and programs
providing advocacy and support services to
child and adult victims and survivors who have
experienced abuse and trauma. In addition to
victim advocates who may be employed by the
CAC, there may be advocates on staff in law
enforcement agencies, prosecutors’ offices,
domestic and sexual violence community-
based agencies, hospitals, and CASA
programs, among others. While specific job
titles may vary, children and families engaged
with the CAC/MDT may also be receiving
services from some or all of these agencies/
programs. To better understand each other’s
roles, optimize cross-referrals for CAC clients,
avoid unnecessary duplication and ensure
meaningful coordination of services, the CAC
must develop a process for achieving these
goals in collaboration with one another. This
process will need to include understanding
and respect for issues of confidentiality and
methods for sharing case-specific information
accordingly.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 35
05. Medical Evaluation
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05. Medical Evaluation
Standard 05
Medical
Evaluation
Specialized medical evaluation and treatment services
are available to all CAC clients and are coordinated
as part of the multidisciplinary team response.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 37
05. Medical Evaluation
Rationale
All children who are suspected victims of
child sexual abuse are entitled to a medical
evaluation by a health care provider with
specialized training and expertise. The
collection and documentation of forensic
findings are vital. However, the referral of
children for medical examinations should
NOT be limited to those where forensically
significant findings are anticipated. Medical
evaluations should be prioritized as emergent,
urgent, and non-urgent based on specific
screening criteria. Said criteria must be
developed by specially trained and skilled
medical providers, who may be those serving
on local multidisciplinary teams. Additional
considerations include the ability to conduct
follow-up examinations to reassess findings
and conduct further testing where deemed
necessary.
A medical evaluation holds an important place
in the multidisciplinary assessment of child
abuse. An accurate and complete history is
essential in making medical diagnoses and
determining appropriate treatment of child
abuse. Recognizing that there are several
acceptable models that can be used to obtain
a history of the abuse allegations, and that
forensic interview techniques are specialized
skills that require training, information
gathering must be coordinated with the MDT
to avoid duplication. Because many children
are familiar with the helping role of doctors
and nurses, they may disclose information to
medical personnel that they might not share
with investigators. In fact, some children are
able to describe residual physical symptoms
to medical providers even when no injury is
seen. If a nonmedical member of the MDT is
conducting the in-depth forensic interview,
further medical history will still likely be needed
from the caregiver and/or child to complete
the medical evaluation. As such, information
gathering and sharing must be coordinated
to avoid duplication and help ensure a
comprehensive response (see Med-Appendix
1 for an example of Components of Medical
History for Child Sexual Abuse Evaluation).
Essential Component A
Medical evaluations are conducted by health
care providers with specific training in child
sexual abuse who meet at least ONE of the
following training standards:
1. Child Abuse Pediatrics Subboard eligibility
or certification
2. Physicians without board certification
or eligibility in the field of child abuse
pediatrics, advanced practice nurses,
and physician assistants should have a
minimum of 16 hours of formal didactic
training in the medical evaluation of child
sexual abuse (see Med-Appendix 2)
3. Sexual assault nurse examiners (SANEs)
without advanced practitioner training
should have a minimum of 40 hours
of coursework specific to the medical
evaluation of child sexual abuse followed
by a competency- based clinical
preceptorship with an experienced
provider in a clinical setting, where the
SANE can demonstrate competency in
performing exams (see Med-Appendix 2
or IAFN guidelines)
STATEMENT OF INTENT
Physicians, advanced practice nurses, physician
assistants and SANEs without advanced
practice training may all engage in medical
evaluations of child abuse. Due to differences
05. Medical Evaluation
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05. Medical Evaluation
in foundational training in pediatric assessment
by provider type (see Med-Appendix 2), the
above training and eligibility standards must
be met by the health care provider of a CAC
(regardless of whether the exams are occurring
on- or off-site).
All providers should be licensed to practice
and be in current good standing by their
corresponding state board of practice
regulation. Nurses must practice within the
scope of their applicable state nurse practice
acts. A medical director (physician or advanced
practice nurse) is needed for non-advanced
practice nurses to assist with the development
of practice protocols and the treatment
needs of the patient, including referrals for
other medical or mental health issues that
are discovered during the evaluation. The
medical director may or may not also meet
qualifications as an “advanced medical
consultant” (as defined in the “Continuous
Quality Improvement” section) who can
perform review of examination findings. If
the medical director does not also serve as
a medical provider for the CAC, this person
should, at a minimum, be familiar with the
essential components of the medical standard
and the mission of the CAC.
Some CACs have qualified medical providers
as full- or part-time staff, while others provide
this service through affiliation and linkage
agreements with local providers or regional
facilities. Whether the exams occur on-site
or off-site, or by CAC staff or via a linkage
agreement, the medical provider must meet
the Training and Eligibility Standards for
Training (above) and Continuous Quality
Improvement.
Continuous quality improvement (CQI) for the
CAC’s medical component:
The medical provider must be familiar and
up to date with published research studies
on findings in abused and non-abused
children, sexual transmission of infections in
children, and current medical guidelines and
recommendations from national professional
organizations such as the American Academy
of Pediatrics Committee on Child Abuse and
Neglect, the American Professional Society
on the Abuse of Children, and the Centers
for Disease Control and Prevention. Accuracy
in interpretation of examination findings is
vitally important to the child, family, and the
MDT as a whole. The medical provider must
provide documentation of participation in
CQI activities, including continuing education
and expert review of positive findings with an
“advanced medical consultant” in order to stay
current in the field of child sexual abuse.
Essential Component B
Medical professionals providing services to
CAC clients must demonstrate continuing
education in the field of child abuse consisting
of a minimum of eight contact hours every
two years.
Teaching experience in the area of child abuse
that is approved to provide CEU or CME
activity also qualifies for ongoing education
credit.
Essential Component C
Medical professionals providing child
sexual abuse evaluations to CAC clients
must demonstrate that all findings deemed
abnormal or “diagnostic” of trauma from
sexual abuse have undergone expert review
by an “advanced medical consultant.”
•
Expert review with a child abuse
pediatrician is preferred and can occur
in multiple ways, including via a direct
linkage agreement with a specific provider,
through myCasereview sponsored by the
Midwest Regional CAC, or through other
identified state-based medical expert
review systems that have access to an
“advanced medical consultant.”
•
Physicians or advanced practice nurses can
also provide said review if they have the
following qualifications:
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 39
05. Medical Evaluation
Ε
Meet the minimum training standards
outlined for a CAC medical provider
Ε
Have performed at least 100 child
sexual abuse exams
Ε
Are current in CQI requirements
The CAC and medical provider must work
collaboratively to establish a method to track
de-identified case information as part of the
CQI process (see Med-Appendix 3).
STATEMENT OF INTENT
The accuracy and integrity of forensic medical
evaluation findings is critically important in child
sexual abuse cases. While a small percentage
of medical evaluations result in a positive or
diagnostic finding for sexual abuse (about
3–5% in the literature), it is critical to both the
future safety of the child and the integrity of
any criminal justice case that the findings are
accurate. Research indicates that the most
important in diagnostic accuracy over time
is consistent review. Because a false positive
(“overcalling”) can lead to a miscarriage of
justice, given the reliance of MDT members on
medical findings in making charging decisions
and the reliance on such findings at trial, it is
essential to have 100% of all medical findings
diagnostic for child sexual abuse reviewed by
an advanced medical consultant.
The medical provider must be able to provide
documentation of participation in expert review
with an “advanced medical consultant” on all
abnormal sexual abuse exams for the purpose
of CAC case-tracking information that could
be requested for review in the accreditation
process.
The providers who qualify as “advanced
medical consultants” to offer expert review
of examination findings are listed above in
the essential component, as is the critical
importance of collaboratively establishing the
required CQI process.
Essential Component D
Specialized medical evaluations for child
clients are available on-site or through
linkage agreements with other appropriate
institutions, agencies, or providers.
STATEMENT OF INTENT
Specialized medical evaluations can be
provided in a number of ways. Some CACs
have a qualified medical provider who comes to
the center on a scheduled basis, while in other
communities, the child is referred to a medical
clinic or health care agency for this service.
CACs need not be the primary care provider,
but they must have protocols in place outlining
and facilitating the linkages to a facility with a
qualified medical provider and other needed
health care services.
Essential Component E
Specialized medical evaluations are available
and accessible to all CAC clients regardless of
ability to pay.
STATEMENT OF INTENT
In many communities, the cost of a medical
evaluation is covered by public funds. In other
settings, limited public funding requires that
individuals who can pay or are insured cover
the cost of their own examinations, or for those
clients who require support, MDT members
can help facilitate reimbursement through
victim compensation. Regardless of the source
of funding for the examinations, ability to pay
should never be a factor in determining who is
offered and able to access a medical evaluation.
Essential Component F
CAC/MDT written protocols and guidelines
include access to appropriate medical
evaluation and treatment for all CAC clients.
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05. Medical Evaluation
STATEMENT OF INTENT
Because medical evaluations are a critical
component of the CAC’s multidisciplinary
response, the CAC’s written protocols must
detail how its clients access these services.
Many CACs provide services to victims of
physical abuse and neglect as well as to
victims of sexual abuse. All CACs must have
written protocols and agreements outlining
how medical evaluations for all types of abuse
and neglect should occur. CACs that provide
medical evaluations for sexual abuse, but not
specifically for physical abuse or neglect, must
include written procedures for how to access
medical evaluations for alleged physical abuse
or neglect, including treatment for injuries and
management of emergency or life-threatening
conditions that may become evident during a
sexual assault exam.
Essential Component G
CAC/MDT written protocols and guidelines
include the circumstances under which a
medical evaluation for child sexual abuse is
recommended, provided, and accessed.
STATEMENT OF INTENT
The purpose of a medical evaluation in
suspected child abuse extends far beyond
providing an evidentiary examination for the
purpose of the investigation. The primary
goals of the medical evaluation are to:
•
Help ensure the health, safety, and well-
being of the child
•
Evaluate, document, diagnose and address
medical conditions resulting from abuse
•
Differentiate medical findings that are
indicative of abuse from those which may
be explained by other medical conditions
•
Document, diagnose and address medical
conditions unrelated to abuse
•
Assess the child for any developmental,
emotional, or behavioral issues needing
further evaluation and treatment and make
referrals as necessary
•
Educate the child and family regarding all
aspects of the medical examination and
outcomes
•
Provide support relative to any
recommended next steps and reassurance
regarding child’s overall health and well-
being
•
Make recommendations regarding mental
health and other services to address
trauma related to the abuse/assault in
coordination with other members of the
MDT/CAC
CACs differ in their practices for how
medical evaluations are made available. The
MDT’s written protocols or agreement must
include qualified medical input to define the
referral process and how, when and where
examinations are made available. Examinations
can be differentiated between those needed
emergently (without delay), urgently (scheduled
as soon as possible with a qualified provider),
or nonurgently (scheduled at the convenience
of family and provider but ideally within 1–2
weeks). Some patients may also benefit from
a follow-up examination (see Med-Appendix
4). CACs are responsible for ensuring that
exams are performed by experienced,
qualified medical providers at the appropriate
location and time, and that examinations are
photo-documented to minimize unnecessary
repeat examinations. This often requires initial
conversations with emergency departments
and primary care providers to develop a
process for referral to the specialized medical
provider as defined by the needs of the child.
Essential Component H
Documentation of medical findings is
maintained by written record and photo-
documentation. Medical records storage must
be HIPAA compliant. The medical records
storage must be secured, sufficiently backed
up and accessible to authorized personnel
in accordance with all applicable federal and
state laws.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 41
05. Medical Evaluation
STATEMENT OF INTENT
The medical history and physical examination
findings must be carefully, thoroughly, and
legibly documented in the medical record.
The medical record should also include a
statement as to the significance of the findings
and treatment plan. Medical records should
be maintained in compliance with federal
rules governing protection of patient privacy.
Medical records may be made available to
other medical providers for the purpose of
needed treatment of the patient and to those
agencies mandated to respond to a report of
suspected child abuse. Even in situations where
the medical record can legally be provided
without separate written consent or court order,
a log of disclosures should be maintained with
the medical record in accordance with federal
privacy rules (see Med-Appendix 5).
Diagnostic-quality photographic documentation
of the ano-genital exam findings should be
obtained in all cases of suspected sexual abuse
using still and/or video documentation. This
is particularly important if the examination
findings are thought to be abnormal.
Photographic documentation allows for
review for CQI and for obtaining consultation
or second opinion and may also obviate the
need for a repeat examination of the child.
CACs should have policies in place for storage
and release of examination images that
protect the sensitive nature of the material.
In the uncommon exception that photo-
documentation is not possible due to the child’s
discomfort with the equipment or equipment
malfunction, diagram drawings with detailed
written description of findings should occur.
Detailed procedures for the documentation
and preservation of evidence (labeling,
processing, and storing) in written protocols
and agreements can help to assure the quality
and consistency of medical evaluations. Such
protocols can also serve as a checklist and
training document for new medical providers.
Many states have mandated forms for recording
findings of a sexual assault exam and guidelines
for the preservation of evidence.
Essential Component I
MDT Members and CAC staff are trained
regarding the purpose and nature of the
medical evaluation for suspected sexual abuse.
Designated MDT members and/or CAC staff
educate children and caregivers regarding the
medical evaluation.
STATEMENT OF INTENT
The medical evaluation for suspected child
sexual abuse often raises significant anxiety
in children and their caregivers, usually due to
misconceptions about how the examination
is conducted and what findings, or lack of
findings, mean. An appropriately trained
medical provider performing the examination
typically addresses this anxiety. In many
CAC settings, the client is introduced to
the examination by nonmedical personnel.
Therefore, it is essential for nonmedical MDT
members and CAC staff to have the training
needed to explain the nature and purpose of a
medical evaluation, and to respond to common
questions, concerns, and misconceptions, to
similarly ease anxiety.
Essential Component J
Findings of medical evaluations are shared with
the MDT in a routine, timely and meaningful
manner.
STATEMENT OF INTENT
Because the medical evaluation is an important
part of the response to suspected child abuse
and neglect, findings of the medical evaluation
should be shared with, and explained to, the
MDT in a routine and timely manner to facilitate
discussion of concerns, and ensure case
decisions can be made effectively. The legal
duty to report findings of suspected child abuse
to child protective services is an exception
outlined by the HIPAA privacy requirements,
allowing for ongoing relevant communications
between and among the members of the MDT.
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06. Mental Health
Standard 06
Mental
Health
Evidence-based, trauma-focused mental health services,
designed to meet the unique needs of the child and caregivers,
are consistently available as part of the multidisciplinary team
response.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 43
06. Mental Health
Rationale
A CAC’s mission is to promote and foster
safety, healing and justice for children and
families. The common focus of the MDT
is to foster healing and avoid potential
retraumatization of children and families by the
systems designed to respond to their needs.
The CAC’s response begins at first contact
with the child and family. Without effective
therapeutic intervention, many children who
have experienced trauma may suffer ongoing
or long-term adverse social, emotional,
developmental and health outcomes.
Evidence-based treatments and other practices
with strong empirical support help reduce
the impact of trauma and the risk of future
abuse and other negative consequences.
For these reasons, an MDT response must
include screening for trauma exposure and/
or symptoms by identified members of the
MDT as part of the MDT response, who then
use that information to link to mental health
services for assessment and trauma-focused
mental health treatment for child victims and
caregivers.
Evidence shows parental/family support is
often the key to the child’s recovery and
ongoing protection, and mental health services
are often an important factor in a caregiver’s
capacity to support their children. Therefore,
family members may benefit from counseling
and support that aids in addressing the
emotional impact of abuse allegations and
related emotional triggers, and in reducing
or eliminating the risk of future abuse. Mental
health treatment for caregivers is a critical
component of CAC services, given that many
may have trauma histories themselves or are
current victims of intimate partner violence.
Such services include information, support
and coping strategies for themselves and their
children about sexual abuse, dealing with
issues of self-blame and grief, family dynamics,
parenting education and the impact of abuse
and trauma histories. Siblings, other children
in the family such as cousins, and, in some
cases, extended family members may also
benefit from opportunities to discuss their
own reactions and experiences and to address
family issues within a confidential therapeutic
setting. The nature of the impact on children
and families underscores the importance of
collaboration with community providers to
improve outcomes for their health and well-
being. The CAC case review process provides
a vehicle for these collaborative discussions.
Essential Component A
Mental health services are provided by
professionals trained in delivering trauma-
focused, evidence-supported mental health
treatment. All mental health providers for
CAC clients, whether providing services on-
site or by referral and linkage agreement with
outside individuals and agencies, must meet
the following training and education/license
requirements:
EDUCATION/LICENSE REQUIREMENT
1. The CAC must demonstrate that its mental
health provider(s) meets at least ONE of
the following academic training standards:
A. Master’s degree/licensed/certified in a
related mental health field.
B. Master’s degree in a related mental
health field and working toward
licensure; supervised by a licensed
mental health professional.
06. Mental Health
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06. Mental Health
C. Student intern in an accredited mental
health related graduate program, when
supervised by a licensed/certified
mental health professional. Both
the student intern and supervising
licensed mental health professional
must meet the indicated 40-hour
training requirements. Students who
are currently enrolled in a training to
deliver an EBT may provide services to
children as a part of their EBT training.
TRAINING REQUIREMENT
2. The CAC must demonstrate its mental
health provider(s) has completed 40
contact hours in training and consultation
calls to deliver an evidence-supported
mental health treatment to children who
have experienced trauma from abuse.
(Examples include TF-CBT, PCIT, AF-CBT,
CFTSI, EMDR — see “Putting Standards
into Practice”). Training programs that
include fewer than 40 hours (including
consultation calls) may be supplemented
with contact hours in evidence-based
assessment.
Essential Component B
Clinicians providing mental health treatments
to CAC clients must demonstrate completion
of continuing education in the field of child
abuse, trauma, clinical practice and/or cultural
applications consisting of a minimum of eight
contact hours every two years.
STATEMENT OF INTENT
Because new research constantly emerges
regarding the efficacy of mental health
treatment modalities and the importance of
ensuring cultural relevance of said services, it
is vital for clinicians to remain updated about
new research, evidence-supported treatment
methods, and developments in the field that
would help ensure the delivery of high-quality,
relevant, and accessible services to clients.
Essential Component C
Evidence-supported, trauma-focused mental
health services for the child client are
consistently available and include:
1. Trauma-specific assessment of traumatic
events and abuse-related trauma
symptoms to determine the need for
treatment;
2. Evidence-based assessments to inform
treatment;
3. Individualized treatment plan based
on assessments that are periodically
reassessed;
4. Individualized evidence-supported
treatment appropriate for the child clients
and other family members;
5. Child and caregiver engagement in
treatment;
6. Monitoring of trauma symptom reduction;
7. Referral to other community services as
needed.
All services should be culturally informed and
culturally responsive.
STATEMENT OF INTENT
The above description of services should
guide discussions about expectations with
all professionals who may provide mental
health services, whether on-site or by referral
and linkage agreement. This will ensure that
appropriate, relevant, and accessible services
are available for child clients and that the
services are outlined in linkage agreements.
Essential Component D
Mental health services are available and
accessible to all CAC clients regardless of
their ability to pay.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 45
06. Mental Health
STATEMENT OF INTENT
CACs have a responsibility to identify and
secure alternative funding sources to ensure
all children and caregivers have access to
appropriate, specialized mental health services.
Essential Component E
The CAC/MDT’s Interagency Agreement/MOU
or written protocols and guidelines include
access to appropriate trauma-informed mental
health assessment and treatment for all CAC
clients.
STATEMENT OF INTENT
Because mental health is a core component of
a CAC’s multidisciplinary team response, the
CAC/MDT’s Interagency Agreement/MOU or
written protocols and guidelines must detail
how such care may be provided and accessed
by all CAC clients.
Essential Component F
The CAC/MDT’s written protocols and
guidelines define the role and responsibility of
the mental health professional(s) on the MDT,
to include:
1. Attending and actively participating in
MDT case review and case management
2. Sharing relevant information with the
MDT while protecting the clients’
right to confidentiality and the mental
health professional’s legal and ethical
requirements
3. Serving as a clinical consultant to the MDT
regarding child trauma and evidence-based
treatment
4. Monitoring and sharing with the MDT the
child’s and caregiver’s engagement in, and
completion of, treatment.
STATEMENT OF INTENT
Evidence shows the importance of collaboration
among community professionals serving
children and families to improve outcomes. A
trained mental health professional participating
in the MDT case review process assures that
the child’s and caregiver’s treatment needs and
mental health can be monitored, assessed and
reassessed, and taken into account as the MDT
makes case decisions. In some CACs, the child’s
and caregiver’s treatment provider(s) serves in
this role; in others, it may be a mental health
consultant.
Essential Component G
The CAC/MDT’s written protocols and
guidelines include provisions about the sharing
of mental health information and how client
confidentiality and mental health records are
protected in accordance with state and federal
laws.
STATEMENT OF INTENT
The forensic process of gathering evidentiary
information and determining what the child
may have experienced is separate from mental
health treatment processes. Mental health
treatment is a clinical process designed to
assess and mitigate the long-term adverse
impacts of trauma and/or other diagnosable
mental health conditions. Every effort should
be made to maintain clear boundaries between
these roles and processes.
Each CAC must be aware that medical and
mental health treatment records containing
identifiable protected health information (PHI)
are protected by HIPAA. Records pertaining
directly to an investigation of child abuse can
be exempt from HIPAA and do not require
caregiver consent for release. The CAC should
maintain a log of disclosures of medical and
mental health treatment information per HIPAA
regulations.
MDT protocol must include specific guidelines
for the MDT and mental health providers
regarding what and how information can be
shared with the MDT during case review, in
accordance with state laws and professional
ethical practice standards.
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06. Mental Health
Essential Component H
The CAC must provide services for caregivers
to address:
1. Safety and well-being of the child
2. Caregiver involvement in their child’s
treatment when appropriate
3. Emotional impact of abuse allegations
4. Risk of future abuse
5. Issues or distress that the allegations may
trigger, including own history of trauma
and/or current experience of abuse,
violence and/or other trauma
These services may be provided directly by
the CAC and/or with linkage agreements with
other appropriate providers.
STATEMENT OF INTENT
Evidence clearly demonstrates that caregiver
support is essential to sibling support, the
recovery of children directly experiencing
or exposed to abuse and violence, and
overall family functioning and well-being.
CACs have long provided such supportive
services for caregivers and siblings through
support groups, mental health services and
ongoing follow-up, either on-site or by linkage
agreement.
It is important to consider the range of mental
health issues that could impact the child’s
recovery or safety with particular attention to
the caregiver’s mental health, substance abuse,
domestic violence, and other trauma history.
Caregivers, siblings, and other family members
may benefit from assessment, support, and
mental health treatment to address the
emotional impact of abuse allegations, reduce
or eliminate the risk of future abuse, and
address issues that the allegations may trigger.
Assessments and supports may be provided by
clinicians, victim advocates or others, either on
staff at the CAC or via linkage agreement.
Essential Component I
Clinicians providing mental health treatment
services to CAC clients must participate
in ongoing clinical supervision and/or
consultation.
STATEMENT OF INTENT
Clinical supervision and/or consultation with
others trained in evidence-based treatment is
necessary to ensure appropriate and quality
services to the clients. Moreover, this clinical
supervision is required for licensure in many
states. Individual and/or group supervision
options for meeting this standard include:
•
Supervision by a senior clinician on staff at
the CAC
•
Supervision with a senior clinician in the
community who serves children and
families and accepts referrals from the
CAC (when a CAC does not have more
than one clinician)
•
Participation in a supervision call with
mental health providers from other CACs
within the state, either individually or as a
group
•
Participation in a State Chapter or one or
more CAC contracts with a senior clinician
to provide supervision and consultation
calls
Most clinical professions (i.e., clinical social
workers, licensed professional counselors,
marriage, and family therapists, etc.) have
a structure for clinicians to become clinical
supervisors. CACs may wish to investigate
this option in their state. CACs can also
negotiate Trauma-Focused Cognitive Behavior
Therapy (TF-CBT) master trainers for ongoing
clinical consultation. As supervision for one
evidence-based treatment does not necessarily
encompass all the clinical interventions needed
within a CAC, comprehensive interventions will
need to be addressed throughout ongoing
clinical supervision.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 47
07. Case Review and Coordination
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07. Case Review and Coordination
Standard 07
Case Review and
Coordination
A formal process in which multidisciplinary discussion
and information sharing regarding the investigation,
case status and services needed by the child and
family is to occur on a routine basis.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 49
07. Case Review and Coordination
Rationale
Case review is the formal process that enables
the MDT to monitor and assess its independent
and collective effectiveness so as to ensure the
safety and well-being of children and families.
The process encourages mutual accountability
and helps to assure that children’s and families’
needs are met sensitively, effectively and in
a timely manner. Case review serves multiple
purposes:
•
Experience and expertise of MDT members
is shared and discussed
•
Collaborative efforts are fostered
•
Formal and informal communications are
promoted
•
Mutual support is provided
•
Protocols and procedures are reviewed
•
Informed, collective decisions are made
•
Services are coordinated
Case review must occur at least once a month.
Its focus is on planning and monitoring current
cases. It is a formal process that serves as
a complement to ongoing case discussions
among the MDT partners. Every CAC must
implement a defined process and set the case
criteria for review. The method and timing of
case review may vary to fit the unique needs
of a CAC community. For example, some
CACs review every open case, while others
review only complex or problematic cases or
cases involved in prosecution. Representatives
from each core discipline on the MDT must
participate and provide input at case review.
Confidentiality should be addressed in the
CAC’s written protocols or guideline, in
keeping with state and/or federal laws and
professional ethics that govern information
sharing among MDT members, including
during case review.
Essential Component A
The CAC/MDT’s written protocols/guidelines
include criteria for case review and case
review procedures.
The CAC/MDT’s written documents must
include:
1. Purpose of meetings
2. Frequency of meetings
3. Designated attendees
4. Case selection criteria and process for
developing case review agenda
5. Designated facilitator and/or coordinator
6. Mechanism for distribution of agenda and
cases to be discussed
7. Procedures for addressing follow-up
recommendations
8. Location of the meeting — may be in
person or virtual
STATEMENT OF INTENT
To maximize efficiency and to enhance the
quality of a comprehensive case review, the
CAC’s written documents clearly define the
process and expectations for all MDT partners.
07. Case Review and Coordination
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07. Case Review and Coordination
Essential Component B
An intentional forum for the purpose of
reviewing, collaborating, and coordinating
cases is conducted at least once a month.
STATEMENT OF INTENT
Case review affords the MDT the opportunity
to review active cases, provide updated case
information, address obstacles to effective
investigations and service delivery, and
coordinate interventions. It is a planned,
regularly scheduled meeting of all MDT
partners and occurs at least once a month for
cases coming from the CAC’s primary service
area. Case review is a formal process that is
conducted in addition to informal discussions
and pre- and post-interview meetings.
Essential Component C
MDT partner agency representatives actively
participating in case review must include, at a
minimum:
1. Law enforcement
2. Child protective services
3. Prosecution
4. Medical
5. Mental health
6. Victim advocacy
7. Children’s Advocacy Center
STATEMENT OF INTENT
Full MDT participation at case review allows
for the contributions of diverse professional
perspectives and expertise to optimize
informed decision-making, case planning and
coordinated service delivery. Case review
must be attended by the identified agency
representatives capable of making, informing
and/or advocating for independent and
collective decisions and providing the team
with knowledge and expertise of their specific
professions. All those participating should
be familiar with the CAC/MDT process and
the purpose and expectations of case review.
Forensic interviewers, irrespective of which
agency employs them, must be present at case
review. Moreover, it is strongly encouraged
that case review participants be those who are
actively working on the cases under review in
order to ensure direct communication between
all parties. This does not preclude additional
agency representatives or supervisors from
participating as well. Participation in person
is optimum; however, participation can be
accomplished virtually as necessary to ensure
the participation of all required disciplines and
to respond to public health emergencies.
Essential Component D
Case review is an informed and collaborative
decision-making process with input from all
MDT partner agency representatives.
Generally, the case review process should
include:
•
Review of forensic interview outcomes
•
Discussion, planning and monitoring of the
progress of the investigation
•
Review of medical evaluation findings
•
Discussion of child protection and other
safety issues
•
Input for prosecution and sentencing
decisions
•
Discussion of emotional support and
treatment needs of children and family
members and strategies for meeting those
needs
•
Assessment of the family’s reaction and
response to the child’s disclosure and
involvement in the criminal justice and/or
child protection systems
•
Review of criminal and civil (dependency)
case updates and ongoing involvement
with the child and family as well as
disposition
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 51
07. Case Review and Coordination
•
Provisions for court education and court
support and accompaniment
•
Discussion of issues of cultural relevance
and needs unique to individual children
and families, including issues pertaining to
access to services
•
Ensuring that all children and families
are afforded the legal rights and
comprehensive services to which they are
entitled
•
Discussion of how the CAC and MDT
intervention is impacting the child and
their family, including positive changes and
challenges
•
Child well-being and outcomes, as available
STATEMENT OF INTENT
In order to make informed case decisions,
optimize service delivery and improve
client outcomes, essential information and
professional expertise are required from all
disciplines. Decisions and interventions must
be made with the input, discussion and support
of all involved professionals, and efforts
must be coordinated, comprehensive and
nonduplicative. The process and facilitation
must ensure there is equitable participation
and discussion among all MDT members to
adequately address their respective and shared
goals, mandates, interventions and services,
questions, concerns, and outcomes.
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08. Case-Tracking
Standard 08
Case-Tracking
Children’s Advocacy Centers must develop and
implement a system for monitoring case progress and
tracking case outcomes for all MDT components.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 53
08. Case-Tracking
Rationale
Case-tracking systems are able to collect
and document essential demographic
and case information and investigation/
intervention outcomes as well as generate
statistical reports. The data collected is useful
for monitoring ongoing case progress and
program evaluation to inform continuous
quality improvement, enabling MDT members
to provide accurate information on the current
status and disposition of cases to clients, and
providing critical support for seeking funding
and responding to grant requirements.
Data collected nationally from all local
programs, relevant statewide and regionally,
are useful for advocacy, research, and
legislative purposes to advance the field of
child maltreatment. It may also be required
for federal funding reporting requirements.
Each CAC utilizes the case-tracking system
that suits its determined needs and is able
to be supported by its available resources.
Any case-tracking system implemented must
be compliant with all applicable privacy and
confidentiality requirements.
Essential Component A
The CAC/MDT’s written protocols/guidelines
includes the case-tracking process and
information gathered through case closure at
the CAC, including final civil and/or criminal
disposition.
STATEMENT OF INTENT
Case tracking provides a mechanism for
monitoring case progress throughout the
multidisciplinary interagency response.
Often, MDT members will have a system to
collect their own agency data; however, the
MDT response requires the sharing of this
information among its members to better
inform individual and collective decision-
making, ensure accurate updates to children
and families, and inform quality improvements
in coordinated service delivery. The CAC/
MDT’s written documents must detail the
CAC’s purpose, information to include, and a
process for case tracking.
Essential Component B
The CAC tracks and, at a minimum, is able
to retrieve and report NCA Statistical
Information.
NCA statistical information includes the
following data:
1. Demographic information about the child
and family
2. Demographic information about the
alleged offender
3. Type(s) of alleged abuse
4. Relationship of alleged offender to child
5. MDT members’ involvement with children
and families and relevant outcomes
6. Criminal charges filed and case
dispositions
7. Child protection outcomes
8. Status/follow-through of medical and
mental health referrals
08. Case-Tracking
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08. Case-Tracking
STATEMENT OF INTENT
CACs are required to demonstrate the ability
to collect and retrieve case-specific information
for all CAC clients. This includes basic
demographic information, services provided,
and outcome information contributed by MDT
partner agencies in a thorough and timely
fashion. Codifying case-tracking procedures
in CAC/MDT’s written documents underscores
its importance and helps to assure the MDT
members are accountable to each other and,
ultimately, to the children and families they
individually and collectively serve.
Essential Component C
An individual is identified to implement the
case-tracking process.
STATEMENT OF INTENT
Case tracking is an important function of
the CAC that requires dedicated time and
accuracy in its implementation. A designated
individual(s) must be identified to implement
and/or oversee the case-tracking process,
and the number and type of individual(s)
charged with this responsibility is determined
by the CAC’s staffing and case volume. Some
CACs define case tracking as part of the MDT
coordinator’s or case manager’s role. Some
dedicate a staff position, part- or full-time, for
data collection and database maintenance, or
assign the responsibility to an administrative
assistant. Other programs utilize trained
volunteers (who have signed confidentiality
agreements) to input data.
Essential Component D
The CAC/MDT’s written protocols/guidelines
must outline how MDT partner agencies
can access case-specific information and
aggregate data for quality assurance, quality
improvement, funding, and research purposes.
STATEMENT OF INTENT
Because case data may be useful to MDT
members for a variety of purposes, it is
important that all members have access to
aggregate and/or specific case information
as determined through discussions with
all participating agencies. Policies must
also include how the release of this data
to participating agencies and other parties
complies with confidentiality requirements.
Essential Component E
The CAC collects client feedback to inform
client service delivery.
STATEMENT OF INTENT
Continuous quality assurance is the hallmark of
a well-functioning CAC. This requires seeking
feedback directly from clients regarding their
experiences with all aspects of CAC services
so that improvements may be made as needed
on an ongoing basis. Soliciting client feedback
can be accomplished through the use of
various tools including, but not limited to, client
satisfaction surveys. To optimize the quality
of the feedback received, survey instruments
need to be valid and reliable. CACs that
actively participate in NCA’s Outcome
Measurement System (OMS) can be assured
they meet and exceed this requirement.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 55
09. Organizational Capacity
PAGE 56 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
09. Organizational Capacity
Standard 09
Organizational
Capacity
A designated legal entity responsible for program
and fiscal operations has been established and
implements basic sound administrative policies and
procedures.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 57
09. Organizational Capacity
Rationale
Every CAC must have a designated legal
entity responsible for the governance and
implementation of its operations. This entity
oversees ongoing business practices of the
CAC, including setting and implementing
administrative policies, hiring, and managing
personnel, obtaining funding, supervising
program and fiscal operations, and long-
term planning. CAC organizational structure
depends upon the unique needs and resources
of its community; it may be an independent
nonprofit agency, a component of an umbrella
organization such as a hospital or nonprofit
human service or victim service agency, or part
of a governmental entity, such as prosecution,
social services, or law enforcement. Each
of these options has strengths, limitations
and implications for collaboration, planning,
governance, community partnerships and
resource development. Regardless of where
the program is housed or under what legal
auspices, all CACs must create a structure
such that participating agencies feel equal
investment in, and collaborative responsibility
for, its operations and services.
Essential Component A
The CAC is an incorporated, private nonprofit
organization, government-based agency,
tribal entity, or a component of such an
organization, agency, or tribal entity.
STATEMENT OF INTENT
The CAC has a defined organizational identity
that ensures appropriate legal and fiduciary
governance and organizational oversight. This
is critical to the ability to maintain, grow and
ensure sustainability of the CAC and all of its
components and services.
Essential Component B
The CAC maintains, at a minimum, current
general commercial liability, professional
liability, directors’ and officers’ liability, and
cyber liability insurance as appropriate for its
organization.
STATEMENT OF INTENT
Every CAC must provide appropriate insurance
for the protection of the organization and its
personnel. Nonprofit CACs, including those
that are a component of an umbrella nonprofit
or nonprofit hospital, must carry, at a minimum,
general commercial liability, professional
liability, cyber liability, and directors’ and
officers’ liability insurance. Government-
based CACs must carry, at a minimum,
general commercial liability, professional
liability, and cyber liability insurance or
provide documentation of comparable
coverage through self-insurance. CACs should
consult with appropriate risk management
professionals to determine appropriate types
of insurance and any additional levels of
coverage needed, including renters, property
owners and automobile insurance, depending
upon their individual needs.
Essential Component C
The CAC has administrative policies and
procedures that apply to staff, board
members, volunteers, and clients.
Every CAC must have written policies and
procedures that govern its administrative
operations. Administrative policies and
procedures must include, at a minimum:
1. Personnel policies, procedures, and
documents
09. Organizational Capacity
PAGE 58 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
09. Organizational Capacity
A. Job descriptions for all positions
B. Anti-discrimination policy
C. Conflict of interest policy
D. Whistleblower policy
E. Social media use policy
2. Financial management policies and
procedures
A. Accounting policies and procedures
that demonstrate adequate internal
controls and segregation of duties
B. Credit card usage policy
3. Safety and security policies and
procedures
A. Code of conduct (this should guide
behavior between staff, between staff
and team members, and between
staff/team members and clients)
B. Child protection policies, including the
obligation to report abuse
C. Emergency response policies
D. Building security and safety policy and
procedures
E. Anti-Violence in the Workplace policy
F. Weapons on premises policies and
procedures
G. Drug usage policy
H. Smoke-free environment
4. Information technology policies
A. Document retention and destruction
policies
B. Data security policies
C. Confidentiality policies — HIPAA
requirements
STATEMENT OF INTENT
The CAC has clearly developed organizational
policies and procedures that ensure
appropriate administrative governance. This
is critical to the ability to maintain, grow and
ensure sustainability of the CAC and all of its
components and services.
Essential Component D
The CAC is required to conduct an annual
independent financial audit when its annual
actual expenses meet or exceed $750,000.
Organizations whose annual gross expenses
fall below $750,000 and meet or exceed
$200,000 must conduct a CPA-completed
financial review. Those organizations with
gross annual expenses below $200,000
must provide their Board-approved financial
statements.
STATEMENT OF INTENT
Confidence in the integrity of the fiscal
operations of the CAC is critical to the long-
term sustainability of the organization. An
annual independent audit is one tool to assess
for fiscal soundness and internal controls for
financial management. A financial review is
sufficient for those CACs with annual actual
expenses equal are less than $750,000 and that
meet or exceed $200,000. CACs with annual
budgets below $200,000 must provide their
Board-approved financial statements.
Reporting Requirements for Audited Financial
Statements: All centers with annual actual
expenses (as determined by United States
generally accepted accounting principles)
that meet or exceed $750,000 are required
to have an audit of their financial statements.
If a management letter is prepared by the
independent accountant (CPA), it should be
included with the audit report.
Reporting Requirements for Reviewed Financial
Statements: All centers with annual actual
expenses (as determined by United States
generally accepted accounting principles) less
than $750,000 that meet or exceed $200,000
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 59
09. Organizational Capacity
are required to have a review of their financial
statements. The review must be in compliance
with SSARS 19. If a management letter is
prepared by the independent accountant
(CPA), it should be included with the review
report.
Essential Component E
The CAC has, and demonstrates compliance
with, written screening policies for staff,
board members and volunteers that include
national criminal background, sex offender
registration, and child abuse registry checks,
and it provides training and supervision to
staff and on-site and/or ongoing volunteers.
In discussion with its Board and MDT, a CAC
must determine what is a disqualifying finding
in a background check.
STATEMENT OF INTENT
Due to the sensitive and high-risk nature
of CAC work, it is imperative that the CAC
conduct a formal screening process for staff.
This process should be documented in a
written policy. Staff must receive initial and
ongoing training and supervision relevant to
their role.
In addition, volunteers perform a wide variety
of functions within CACs, and CACs can attract
volunteers who are emotionally unprepared for
the nature and expectations of the work and/
or individuals who have potential to be, or have
current or past histories as, offenders. Due to
the sensitive and high-risk nature of CAC work,
it is imperative that the CAC also conducts a
formal screening process for on-site volunteers.
Upon placement, volunteers must receive
training and supervision relevant to their roles.
For similar reasons, screening must be
conducted for board members as they serve
and publicly represent the CAC in a variety of
ways, both on- and off-site.
Essential Component F
The CAC has a written succession plan to
ensure the orderly transition and continued
operation of the CAC.
STATEMENT OF INTENT
A succession plan assists in guiding the CAC
through, and safeguarding the CAC against,
unplanned or unexpected changes. This kind
of risk management, mission and business
continuity is equally important in facilitating
a smooth transition when leadership change
is predictable and planned. A succession
plan outlines leadership development and
emergency responsibilities for the CAC, and
it reflects its commitment and helps ensure a
sustained, healthy functioning organization.
The plan should be developed specific to
the uniqueness of the CAC and include, at a
minimum:
•
Temporary staffing strategies
•
Long-term and/or permanent leadership
replacement procedures
•
Cross-training plan
•
Financial considerations
•
Communication plan
•
Key positions/functions essential to the
operation of the CAC
Essential Component G
The CAC has addressed its sustainability
through the implementation of a current
strategic plan approved by the governing
entity of the CAC.
STATEMENT OF INTENT
In order to assure long-term viability of the
organization, the CAC must have a plan that
addresses programmatic and operational
needs. The governing entity for such a plan
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09. Organizational Capacity
may be an oversight committee or a board
of directors, as appropriate for the individual
CAC’s organizational structure and needs.
In general, in order to be considered
current, a strategic plan should be no more
than three to five years old. It should be
actively implemented, and there should be a
mechanism in place to monitor the progress on
the plan.
Plan should include at, a minimum:
•
Stakeholder input in plan creation
•
Goals, objectives, and timeline
•
Review and approval by CAC board or
relevant governing body
Essential Component H
The CAC promotes employee well-being by
providing training and resources regarding
the effects of vicarious trauma, providing
techniques for building resiliency, and
maintaining organizational and supervisory
strategies to address vicarious trauma and its
impact on staff.
STATEMENT OF INTENT
To help ensure the health and well-being of all
employees and improve employee retention,
the CAC must raise awareness about the
impact of work-related trauma exposure
through training and develop organizational
practices that identify and mitigate against
negative consequences for staff, the delivery
of quality of services, and staff turnover.
This includes identifying the risk of vicarious
trauma for frontline staff and those exposed
to the associated trauma of the work more
indirectly. It also includes providing techniques
for individual self-care and resiliency building
as well as integrating and maintaining
organizational and supervisory strategies
to address and respond to vicarious trauma
among all staff.
Essential Component I
The CAC provides training opportunities and
resources on vicarious trauma and building
resiliency to all MDT members.
STATEMENT OF INTENT
CACs have a primary role in building and
enhancing the functioning of the MDT. A
highly functioning MDT assures vicarious
trauma is acknowledged and addressed and
has an awareness and understanding of the
importance of work-related trauma exposure
and its potential consequences. While MDT
partner agencies have primary responsibility
for the health and well-being of their respective
staff, the CAC is responsible for providing
access to training, ongoing recognition, and
discussion and strategies to collaboratively
address vicarious trauma and help build team
members’ resiliency. Moreover, the health of
the MDT as a whole directly impacts service
delivery to children and families. Therefore,
attention to this issue is important for helping
to ensure high-quality services and improve
outcomes for abused children and families.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 61
10. Child Safety and Protection
PAGE 62 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
10. Child Safety and Protection
Standard 10
Child Safety
and Protection
The CAC is comfortable, private and both physically and
psychologically safe for diverse populations of children and
their family members.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 63
10. Child Safety and Protection
Rationale
A CAC requires a separate, child/youth-
focused setting that provides a safe,
comfortable, and neutral place where forensic
interviews and other CAC services can be
appropriately provided for children and
families. While every center may look different,
the criteria below help define specific ways
the environment can help children and families
feel physically and psychologically safe and
comfortable. These include making sure
the physical setting meets basic child safety
standards, ensuring alleged offenders do not
have access to the CAC, providing adequate
supervision of children and families while they
are on the premises, and creating a welcoming
environment that reflects the diversity of clients
served.
There is no one right way to build, design
or decorate a CAC. The CAC should have
adequate square footage for its determined
on-site operations and conform to generally
accepted safety and accessibility guidelines,
fire codes, etc. Consideration should be given
to future growth and the need for additional
space as caseloads increase and additional
program components are needed. Care should
be taken to ensure MDT members have access
to workspace and equipment on-site to carry
out the necessary functions associated with
their roles on the MDT, including, but not
limited to, meeting with families, participating
in forensic interviews and sharing necessary
information.
Special attention should be given to designing
and decorating the client service areas to
reflect the community’s diverse population.
The appearance of the CAC can help facilitate
the participation of children and families in the
process, largely by helping alleviate anxiety
and instill confidence and comfort in the
intervention system. It should communicate,
through its design, decor, and materials, that
the CAC is a welcoming place for all children
and their nonoffending family members.
Essential Component A
The CAC is a designated, task-appropriate
facility or space that:
1. Is maintained in a manner that is physically
and psychologically safe for children and
families
2. Provides observation or supervision of
clients within sight or hearing distance by
CAC staff, MDT members or volunteers at
all times
3. Is convenient and accessible to clients and
MDT members
4. Is appropriate for the delivery of CAC
services
5. Provides age-appropriate and culturally
diverse toys and other resources that are
childproofed, cleaned, and sanitized to be
as safe as possible.
STATEMENT OF INTENT
The CAC is a child focused setting that ensure
both physical and psychological safety for
all children and families. Special attention
should be paid to the location, design and
accessibility of the CAC for the children,
families and MDT members that utilize the
center.
10. Child Safety and Protection
PAGE 64 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
10. Child Safety and Protection
Essential Component B
The CAC has, and abides by, written policies
and procedures that ensure separation of
victims and alleged adult offenders during the
investigative process and throughout delivery
of services at the CAC. CACs may provide
services to youth with problematic sexual
behaviors, but they must have developed and
implemented appropriate safety protocols to
protect other children receiving services at
the CAC.
STATEMENT OF INTENT
The CAC has written policies and procedures
that ensure the separation of victims and
alleged offenders during the investigative
process and throughout delivery of the full
array of CAC services. During the investigative
process, logic dictates that children will not feel
free to disclose abuse if an alleged offender
accompanies them to the interview and/or
remains on location throughout the duration
of intervention. This separation of children
from alleged offenders should also extend to
children and perpetrators in unrelated cases.
In addition, caregivers may also be at risk of
abuse and violence by alleged offenders and
are in need of physical and psychological
safety for themselves and their children. If a
CAC shares space with an existing agency
that provides services to offenders, facility
features and scheduling must assure separation
between children and family members and
alleged offenders.
Many CACs serve a vital role in their
communities by providing services for children
with problematic sexual behaviors. CACs that
offer services to this population should have
policies and procedures in place to maintain
physical and psychological safety for other
child victims and their families visiting the CAC.
Essential Component C
The CAC makes reasonable accommodations
to make the facility physically accessible.
STATEMENT OF INTENT
This requirement is for new buildings and
custom-designed facilities. CACs operating
in older buildings or facilities must make
reasonable accommodations to make the
facility physically accessible to clients and
family members, CAC staff and MDT members.
If the CAC cannot be structurally modified,
arrangements for equivalent services should be
made at alternate locations within or outside
the facility. CACs must be in compliance with
guidelines stipulated in the Americans with
Disabilities Act (ADA) and/or state legislation.
Essential Component D
Separate and private area(s) are available for
confidential case consultation and discussion,
for meetings or interviews, and for clients
awaiting services.
STATEMENT OF INTENT
To ensure a physically and psychologically
safe environment for children and families,
confidentiality and respect for client privacy
is of paramount concern in a CAC. CAC staff
and MDT members require privacy to discuss
cases with children or families in a location
where visitors or others not directly involved
with the case may overhear them. Separate
areas should also be available for private family
member interviews and so that individual
family members may privately discuss aspects
of their case with staff and MDT members.
Care should be taken to ensure that private
meeting areas are not only physically separate
but also soundproofed, so conversations
cannot be overheard. Some centers place
soundproofing materials in or on walls when
building or refurbishing their centers. Others
place stereos or sound machines in rooms to
block sound.
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 65
10. Child Safety and Protection
Essential Component E
CACs are required to implement a code of
conduct for staff and MDT members ensuring
the safety of children and families. The
code of conduct must include child abuse
prevention practices. Staff members must
have received and agreed to the code of
conduct. MDT members must be informed
of the CAC’s code of conduct and the
expectation that it guides work within the
CAC.
Code of conduct content must include:
•
Child safety and well-being as a primary
priority and value in the CAC and one that
guides policy and practice decisions.
•
Contact not related to CAC service
provision between staff and a child/client
is prohibited.
•
Physical contact between child/client and
staff/MDT members must be consistent
with the safety and well-being of the child/
client.
•
Staff interaction with child clients should
be interruptible and/or observable.
•
It is the duty of staff to report suspected
child abuse.
STATEMENT OF INTENT
A code of conduct is a set of rules around the
behavior for CAC staff and MDT members,
and it acts as an explicit expression of personal
and professional expectations in their work
with one another and with clients. It also serves
as an external statement of the CAC/MDT’s
commitment to its core values and principles
for interdisciplinary, cross-agency work. In
addition, a code of conduct helps provide
for a healthy work environment for staff and
MDT members, and thereby helps ensure
the delivery of high-quality, relevant, and
accessible child- and family-centered services.
In the event of any violations of stated codes of
conduct, it also provides an understanding of
how to report and/or address them.
Essential Component F
A child safety assessment must be conducted
annually to ensure that the building and CAC
space is a safe and child-focused setting for
children and their families.
STATEMENT OF INTENT
Core to CACs is their ability to provide a
setting that underscores the critical importance
of providing and/or restoring a sense of safety,
both physically and psychologically, for children
and families in crisis. Safety must be assured if
children and families are able to participate in
forensic interviews, investigations, evaluations
and identified services. As such needs and
safety measures change or are updated,
assessments must be conducted at least
annually.
Essential Component G
CAC staff are mandatory reporters. CACs are
required to ensure that mandated reporter
training is provided to all staff and volunteers.
Updates to state statutes and mandated
reporter laws must be provided to staff and
volunteers annually, if applicable.
STATEMENT OF INTENT
Given the nature of the work of CACs/MDTs,
all those involved in the delivery of services
to children and families must be trained and
understand the requirements of mandated
reporter laws and the procedures for reporting
known or suspected instances of child abuse
and neglect. Annual training is important to
ensure that changes in the law and/or agency
reporting procedures can be understood and
observed.
PAGE 66 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Medical Appendix
Medical Evaluation
Standard
Appendices
The sample resources in the appendix are intended for
resource and example only and are not intended to dictate
how an individual CAC would address specific issues in the
medical standard
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 67
Medical Appendix
History of Present Illness (HPI):
•
History of the event:
Ε
What happened, when, where, who was
involved
•
History of the contact:
Ε
Body sites involved, actions involved,
associated symptoms
•
What has happened since the event?
Ε
Physical/emotional symptoms/behavioral
response
Ε
Safety threats, bullying, school performance
Ε
Family relationships
•
What response has already occurred?
Ε
Prior medical exam and treatment
Ε
Interview by investigators or CAC staff
Ε
Counseling/mental health screening
Past Medical History (PMH):
•
Significant Illnesses/Surgeries/Hospitalizations
•
Development (including sexual development and
menstrual history in girls)
•
Behavioral, educational or mental health issues
•
Prior abuse and sexual history including
consensual partners
•
Medications, allergies and vaccination history
(esp. HPV and Hep B)
Family History (FH):
•
Significant health problems in parents, siblings
and close relatives.
Social History (SH):
•
Home composition, violence in the home,
substance abuse by patient or those in the
home.
•
Does the patient feel safe and supported by
current caretakers?
•
Prior child welfare involvement in the family.
Review of Body Systems (ROS): Ongoing or current
problems/concerns (usually 10 systems)
•
HEENT - Head, Eyes, Ears, Nose, Throat
•
Respiratory-breathing
•
Cardiac- heart
•
Hematology- bruising or bleeding
•
Endocrine - glands,weight gain/loss
•
Neurology-headaches, seizures, balance
•
Gastrointestinal-nausea, vomiting, constipation,
diarrhea, rectal pain/bleeding/DC
•
Genitourinary-discharge, burning, dysuria,
bleeding, pain, lesions
•
Musculoskeletal-(muscles, bones and joints
•
Skin- rashes, lesions, tattoos, bruises
Appendix 1
Medical History for Child Sexual Abuse
COMMON COMPONENTS OF MEDICAL HISTORY FOR POSSIBLE SEXUAL ABUSE
(Needed to guide testing, treatment and make diagnosis)
Sources: Child, Parent/caregiver, Investigator/FI, social work/advocate, medical records. Coordination and
collaboration should occur to avoid duplication in the child being asked to recount details of the abuse event.
PAGE 68 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Medical Appendix
IMPORTANT DEFINITIONS
Didactic Training
Didactic training for CAC medical providers should
cover examination positions (supine, lateral, knee
chest), examination techniques (gathering of
forensic evidence, samples for STI testing, labial
traction, use of cotton swab with pubertal females
to demonstrate edges of hymen, foley catheter,
etc), and the review of multiple examples of:
A. anatomical variants
B. acquired or developmental conditions that
mimic abuse
C. accidental trauma and sexual abuse trauma
D. STIs and forensic evidence
Competency Based Clinical Preceptorship
A preceptorship has a clinical training component
that provides observation and training with
an experienced examiner. The length of the
preceptorship is determined by the time it
takes the trainee to demonstrate competency in
obtaining medical history, using appropriate exam
techniques, obtaining diagnostic quality photo-
documentation, and applying strategies for testing
and prophylaxis for STIs and pregnancy.
TABLE 1: MEDICAL DISCIPLINES, NCA TRAINING REQUIREMENTS AND
CREDENTIALING ENTITY
Foundational Training
Requirements
NCA Training
Requirements
Licensing Entity
Physician
(MD or DO)
Undergraduate Degree
4 years of Medical School
3 years of Residency
1-3 years of Fellowship (optional)
ü
16 hours of formal
didactic training in
the medical
evaluation of Child
Sexual Abuse
State Medical Board
Pediatrics,
Family
Medicine, or
other physician,
Undergraduate Degree
4 years of Medical School
3 years of Residency
State Medical Board
Child Abuse
Pediatrician
Undergraduate Degree
4 years of Medical School
3 years of Residency
3 years of Child Abuse Fellowship
Board certification in Child Abuse
Pediatrics
No additional training
requirements
State Medical Board
Appendix 2
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 69
Medical Appendix
Foundational Training
Requirements
NCA Training
Requirements
Licensing Entity
Advance Practice
Nurse (APRN),
Nurse Practitioner
(NP), Pediatric
Nurse Practitioner
(PNP)
Undergraduate Degree
2 years of Graduate School
Certification Exam
ü
16 hours of formal
didactic training in the
medical evaluation of
Child Sexual Abuse
State Nursing Board
Physician’s
Assistant (PA)
Undergraduate Degree
2 years of Graduate School
Certification Exam
State Licensing Board
Sexual Assault
Nurse Examiner
(SANE)- Adult and
Pediatric
Nursing Degree (RN or BSN)
Licensure Exam
Adult and/or pediatric and
adolescent SANE training
consistent with IAFN guidelines
Competency Based Clinical
Preceptorship
Providers who have completed
SANE training and preceptorship
may also choose to apply
for SANE-A and/or SANE-P
certification by IAFN.
ü
40 hours of formal
didactic training in the
medical evaluation of
Child Sexual Abuse
ü
Competency Based
Clinical Preceptorship
State Nursing Board
Some states have state-
specific forensic nursing
requirements.
PAGE 70 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Medical Appendix
Continuous Quality
Improvement
IMPORTANT DEFINITIONS
Continuous Quality Improvement
is the process-based, data-driven approach to
improving the quality of a product or service.
It operates under the belief that there is always
room for improving operations, processes, and
activities to increase quality.
Advanced Medical Consultant
A Child Abuse Pediatrician, Physician or
Advanced Practice Nurse who:
1. Has met the minimum training outlined for
a CAC provider (see above)
2. Has performed at least 100 child sexual
abuse examinations
3. Current in CQI requirements (continuing
education and participation in expert
review on their own cases)
Expert Review
Expert review of examination findings is a
de-identified continuous quality improvement
(CQI) activity and is NOT a consultation/second
opinion.
1. The CAC should nclude in their policies and
procedures the documentation procedure
for continuous quality improvement .
2. The CAC should track examinations
determined to be abnormal, using either
a patient log kept in a secured location or
through the MDT case review process. The
number of abnormal exams and percent
of exams reviewed by an expert provider
should be available if requested for site
review purposes/practice audits.
3. The medical provider or organization who
provides the expert review should maintain
a de-identified log noting how many
times they have provided examination
review for a specific provider. Notation of
whether consensus was reached is also
recommended.
4. A MOU to delineate roles and
expectations between the CAC/medical
provider and the person serving as the
expert reviewer outlining the roles and
responsibilities should be considered.
EXPERT REVIEW
NCA Medical Standard for Accreditation
states that “all medical professionals providing
services to CAC clients must demonstrate
that 100% of all findings deemed abnormal
or “diagnostic” of trauma from sexual abuse
have undergone expert review by an advanced
medical consultant”.
A. Advanced Medical Consultants as
defined above should also have
abnormal exams reviewed by another
expert.
B. An abnormal exam is one that has
acute or healed physical findings in
the anogenital area indicating that
abuse/assault has occurred. Laboratory
testing for STIs or pregnancy and DNA
evidence collection are NOT included
in the definition of an abnormal exam.
Appendix 3
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 71
Medical Appendix
SAMPLE EXPERT REVIEW LOG
Below is a sample table that can be created in an Excel document or preferred database to track the
review of abnormal exams by an advanced medical consultant. It is recommended that every CAC
Medical provider keep such a log on file for review by NCA Site Reviewers.
Date
Site/examiner
Pre/post
puberty
Examiner findings/
concerns
Reviewer findings
PAGE 72 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Medical Appendix
SAMPLE LANGUAGE FOR MEMORANDUM OF UNDERSTANDING WITH ADVANCED
MEDICAL CONSULTANT
MOU for Expert Review of Examinations with Abnormal Findings
It is understood that the examination review services represent a continuous quality improvement
(CQI) activity and are not intended to serve as medical consultation or provision of direct patient
care so results of CQI activity should not be documented in the patient’s medical record. It is the
responsibility of the medical provider of the CAC to document the findings of the examination in the
patient’s medical record, establish referral protocols with the CAC’s medical director, communicate
the findings with the appropriate MDT members and be available for case review and court testimony
if needed. This MOU for examination review services does not act as or substitute for the role of the
local medical director of the CAC.
A process for tracking information from the examination review process is needed for both CQI as well
as for application for accreditation/re-accreditation with the National Children’s Alliance.
The CAC and/or the medical provider will maintain a de-identified log of the number of cases in which
the medical examination was deemed to represent an abnormal examination. An abnormal exam is
defined as an exam in which acute or healed genital or anal injuries are identified as consistent with
sexual abuse . Abnormal laboratory tests (sexually transmitted infections and pregnancy) and results
of biologic evidence collections are not included in the definition of abnormal exams for the purpose
of this examination review activity.
The medical provider of the CAC will maintain a log documenting the number of cases with abnormal
findings submitted for expert review. Patient information on the log will either be de-identified or
maintained in a secure, locked location to protect sensitive health information.
The medical provider serving as the expert reviewer will maintain a de-identified case log listing the
date, examiner and whether the reviewer agreed with the examiner’s conclusion of abnormal findings
on the examination.
Logs should be maintained for a minimum of 5-years to coincide with the cycle for re-accreditation.
CAC Director
Date
CAC Medical Provider
Date
Expert Reviewer
Date
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 73
Medical Appendix
Appendix 4
Examination Referral and Timing
IMPORTANT DEFINITIONS
Suspected victim of sexual abuse
A suspected victim of sexual abuse may be identified by the following criteria:
1. Disclosure of abuse
2. Witness of abuse by an adult or child
3. Exposure to high-risk offender (i.e. adult in possession of child pornography, sibling/household
contact of a child victim)
TABLE 2: TIMING OF MEDICAL EXAMINATIONS1
Timing of Exam
Medical Indications
Indications for
emergency
evaluation
Exam scheduled
without delay
•
Medical, psychological or safety concerns such as acute
pain or bleeding, suicidal ideation, or suspected human
trafficking
•
Alleged assault that may have occurred within the
previous 72 hours (or other state-mandated time interval)
necessitating collection of trace evidence for later
forensic analysis
•
Need for emergency contraception
•
Need for post-exposure prophylaxis (PEP) for STIs
including Human Immunodeficiency Virus (HIV)
Indications
for urgent
evaluation
Exam scheduled
as soon as
possible with
qualified provider
•
Suspected or reported sexual contact occurring within
the previous 2 weeks, without emergency medical,
psychological or safety needs identified
Indications for
non-urgent
evaluation
Exam scheduled
at convenience
of family and
provider but
ideally within 1-2
weeks
•
Disclosure of abuse by child, sexualized behaviors, sexual
abuse suspected by MDT, or family concern for sexual
abuse, but contact occurred more than 2 weeks prior
without emergency medical, psychological or safety
needs identified
1
Adams JA, Kellogg ND, Farst KJ, Harper NS, Palusci VJ, Frasier LD, Levitt CJ, Shapiro RA, Moles RL, Starling SP,
Updated Guidelines for the Medical Assessment and Care of Children Who May Have Been Sexually Abused, Journal of
Pediatric and Adolescent Gynecology (2015), doi: 10.1016/j.jpag.2015.01.007.
PAGE 74 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
Medical Appendix
Timing of Exam
Medical Indications
Indications
for follow-up
evaluation
As determined by
qualified provider
•
Findings on the initial examination are unclear or
questionable necessitating reevaluation
•
Documentation of healing/resolution of acute findings
•
Confirmation of initial examination findings, when initial
examination was performed by an examiner who had
conducted fewer than 100 such evaluations
•
Further testing or treatment for STIs
THE 5 P’S
Other indications for medical evaluation even if outside of the DNA collection window
1. Pain/bleeding with/after contact
2. Potential for STI’s due to nature of contact
A. Many STI’s do not cause symptoms
3. Perpetrator exposed
A. Sibling/household contacts of the alleged offender
4. Pornography (child) use by caregiver/household contact
5. Patient/parent concern
A. Patients often have distorted thoughts of body due to perpetrator manipulation
B. Initial partial disclosures are common
NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION • PAGE 75
Medical Appendix
Appendix 5
Disclosure Log for Protected Health Information (PHI)
Maintain in patient’s chart
Date
Type of PHI
disclosed
Entity receiving
PHI
Purpose of
Disclosure
(Investigation,
billing, continuity of
care…)
Person making
disclosure
PAGE 76 • NCA | NATIONAL STANDARDS OF ACCREDITATION FOR CHILDREN’S ADVOCACY CENTERS | 2023 EDITION
BACK COVER
ATTACHMENT 4:
A.R.S.§ 12-1518
A.R.S.§ 12-1518. State and political subdivisions; use of arbitration
A. In the discretion of any state agency, board or commission or any political subdivision of this
state, the services of the American arbitration association, or any other similar body, may be used
as provided by this article. Any agreement to make use of arbitration shall be made either at the
time of entering into a contract or by written mutual agreement at a subsequent time prior to the
filing of any civil action.
B. Notwithstanding subsection A of this section, a state agency, board or commission shall include
an agreement to make use of arbitration in all contracts which are subject to mandatory arbitration
pursuant to rules adopted under section 12-133.
C. Notwithstanding subsection A or B of this section, a state agency, board or commission shall
include an agreement to make use of arbitration as provided in this article in public works contracts
if the amount in controversy is less than one hundred thousand dollars.
ATTACHMENT 5:
A.R.S.§ 38-511
A.R.S. 38-511. Cancellation of political subdivision and state contracts; definition
A. The state, its political subdivisions or any department or agency of either may, within three
years after its execution, cancel any contract, without penalty or further obligation, made by the
state, its political subdivisions, or any of the departments or agencies of either if any person
significantly involved in initiating, negotiating, securing, drafting or creating the contract on behalf
of the state, its political subdivisions or any of the departments or agencies of either is, at any time
while the contract or any extension of the contract is in effect, an employee or agent of any other
party to the contract in any capacity or a consultant to any other party of the contract with respect
to the subject matter of the contract.
B. Leases of state trust land for terms longer than ten years cancelled under this section shall
respect those rights given to mortgagees of the lessee by section 37-289 and other lawful provisions
of the lease.
C. The cancellation under this section by the state or its political subdivisions shall be effective when
written notice from the governor or the chief executive officer or governing body of the political
subdivision is received by all other parties to the contract unless the notice specifies a later time.
D. The cancellation under this section by any department or agency of the state or its political
subdivisions shall be effective when written notice from such party is received by all other parties
to the contract unless the notice specifies a later time.
E. In addition to the right to cancel a contract as provided in subsection A of this section, the state,
its political subdivisions or any department or agency of either may recoup any fee or commission
paid or due to any person significantly involved in initiating, negotiating, securing, drafting or
creating the contract on behalf of the state, its political subdivisions or any department or agency
of either from any other party to the contract arising as the result of the contract.
F. Notice of this section shall be included in every contract to which the state, its political
subdivisions, or any of the departments or agencies of either is a party.
G. For purposes of this section, "political subdivisions" do not include entities formed or operating
under title 48, chapter 11, 12, 13, 17, 18, 19 or 22.
ATTACHMENT 6:
Executive Order 2023-01
Protecting Employment Opportunity
Executive Order 2023-01
Protecting Employment Opportunity (amending Executive
Order 2003-22 and Executive Order 2009-09)
WHEREAS, ensuring that Arizona is for everyone requires that every Arizonan should have the
opportunity to participate in the workforce; and
WHEREAS, work provides individuals with the potential for not only a source of income, but also
a source of pride, sense of accomplishment, and social and community interaction; and
WHEREAS, workplace protections are linked to
greater job commitment, improved
workplace relationships, increased job satisfaction, and improved health outcomes of employees;
and
WHEREAS, the personnel, procurement and contracting practices of the State of Arizona should
reflect the State's firm commitment to building an inclusive and diverse workforce for all
Arizonans; and
WHEREAS, the largest personnel system in Arizona state government is the State Personnel
System, which is administered by the Arizona Department of Administration in accordance with its
statutory authority and through regulations and statewide policies and procedures; and
WHEREAS, the Department of Administration administers the Arizona Procurement Portal
which facilitates more than $8 billion in contractual transactions annually with more than 30,000
vendors serving Arizonans in every corner of the state; and
WHEREAS, across the nation, there were more than 35,000 charges of pregnancy discrimination
filed with the U.S. Equal Employment Opportunity Commission from federal fiscal years 2011
through 2021; and
WHEREAS, across the nation, 57% of veterans with a disability report fear of being discriminated
against in hiring practices because of their disabilities; and
WHEREAS, across the nation, more than 40% of lesbian, gay, bisexual and transgender people
report experiencing unfair treatment at work, including being fired, not hired, or harassed based
on their sexual orientation or gender identity; and
WHEREAS, 91 percent of Fortune 500 companies prohibit discrimination based on sexual
orientation, and 83 percent prohibit discrimination based on gender identity;
NOW, THEREFORE, I, Katie Hobbs, Governor of the State of Arizona, by virtue of the power
vested in me by the Arizona Constitution and the laws of this State, do hereby:
1. Affirm the State's commitment to the elimination of all barriers to employment that
artificially restrict hiring, promotion, recruitment, compensation, and tenure based on any
status or characteristic that is not directly related to the performance of the job; and
2. Direct the Department of Administration to establish procedures by April 1, 2023, to be
used by all State Agencies to ensure the following protections for employment opportunity:
a. Adopt policies to ensure that hiring, promotion, recruitment, compensation and
tenure is on the basis of merit and qualifications, is in accordance with all existing
federal, state, and local laws, rules, policies, or executive orders, and prohibit
discrimination based on race, color, sex, pregnancy, childbirth or medical
conditions related to pregnancy or childbirth, political or religious affiliation or
ideas, culture, creed, social origin or condition, genetic information, sexual
orientation, gender identity or expression, national origin, ancestry, age, disability,
military service or veteran status, or marital status.
b. Include provisions in all new state contracts or subcontracts, in accordance with all
existing federal, state, and local laws, rules, policies, or executive orders to prohibit
discrimination based on race, color, sex, pregnancy, childbirth or medical conditions
related to pregnancy or childbirth, political or religious affiliation or ideas, culture,
creed, social origin or condition, genetic information, sexual orientation, gender
identity or expression, national origin, ancestry, age, disability, military service or
veteran status, or marital status by the persons performing the contract or
subcontract.
3. Direct the Department of Administration to continue to research, analyze, and implement
best practices in protecting employment opportunity and to create awareness of the
importance of this issue throughout state government using internal communications,
trainings, and other operational tools.
4. For the purposes of this Order, the term "State Agency" has the same meaning prescribed in
A.R.S.§ 41-741(15). This Order does not apply to, (i) state governmental entities that are
not included in A.R.S. § 41-741(15) and (ii) one or more offices headed by one or more
statewide elected officials. Although these organizations are not included, they are
encouraged, along with all private employers operating in Arizona, to adopt similar
employment opportunity protections.
5. Executive Orders 2003-22 and 2009-09 are hereby deemed amended as necessary to
comply with the terms of this Order, provided, however, that this Order shall not affect the
applicability of federal and State law exemptions as contemplated by Executive Order
2009-09, which exemptions shall remain in full force and effect so long as such exemptions
are enforceable pursuant to State and federal law (as applicable).
6. This Order does not confer any legal rights or remedies upon any persons and shall not be
used as a basis for legal challenges to a State Agency's refusal to consider an applicant for
employment, the removal of an applicant from consideration for employment, the denial
of an employment application, or any inaction of a State Agency.
ATTACHMENT 7:
A.R.S.§ 35-214
A.R.S. 35-214. Inspection and audit of contract provisions
A. Except as provided in subsection C, in all contracts and subcontracts for the furnishing of goods,
equipment, labor, materials or services to the state, or any of its agencies, boards, commissions or
departments, there shall be a provision that all books, accounts, reports, files and other records
relating to the contract shall be subject at all reasonable times to inspection and audit by the state
for five years after completion of the contract. The contract provision shall also require that such
records be produced at such state offices as designated by the state in the contract.
B. Nothing in subsection A shall preclude a more stringent audit requirement agreed to by the parties
in any state contract, and no rule of procedure shall limit the authority of the state to exercise its
rights under this section.
C. This section does not apply to contracts or subcontracts for the furnishing of goods, equipment,
materials or services to any agency, board, commission or department of this state by another
agency, board, commission or department of this state or a political subdivision of this state.
ATTACHMENT 8:
A.R.S.§ 35-215
A.R.S. 35-215. Influencing, obstructing or impairing audit; classification
A person who, with intent to defraud, or deceive, improperly influences, obstructs or impairs an
audit being conducted or about to be conducted in relation to any contract or subcontract with the
state is guilty of a class 5 felony.
ATTACHMENT 9:
A.R.S.§ 35-154
A.R.S. 35-154. Unauthorized obligations; effect; liability
A. No person shall incur, order or vote for the incurrence of any obligation against the state or
for any expenditure not authorized by an appropriation and an allotment. Any obligation incurred
in contravention of this chapter shall not be binding upon the state and shall be null and void
and incapable of ratification by any executive authority to give effect thereto against the state.
B. Every person incurring or ordering or voting for the incurrence of such obligations, and his
bondsmen, shall be jointly and severally liable therefor. Every payment made in violation of the
provisions of this chapter shall be deemed illegal, and every official authorizing or approving
such payment, or taking part therein, and every person receiving such payment, or any part
thereof, shall be jointly and severally liable to the state for the full amount so